hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Washington County Regional Medical Center,1/1/2025,2.0.0,Washington County Regional Medical Center,"610 Sparta Road Sandersville, GA 31082",201646672|GA,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|AETNA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA|COMMERCIAL,standard_charge|AETNA|COMMERCIAL|methodology,additional_payer_notes|AETNA|COMMERCIAL,standard_charge|AMBETTER|COMMERCIAL|negotiated_dollar,standard_charge|AMBETTER|COMMERCIAL|negotiated_percentage,standard_charge|AMBETTER|COMMERCIAL|negotiated_algorithm,estimated_amount|AMBETTER|COMMERCIAL,standard_charge|AMBETTER|COMMERCIAL|methodology,additional_payer_notes|AMBETTER|COMMERCIAL,standard_charge|AMERIGROUP|COMMERCIAL|negotiated_dollar,standard_charge|AMERIGROUP|COMMERCIAL|negotiated_percentage,standard_charge|AMERIGROUP|COMMERCIAL|negotiated_algorithm,estimated_amount|AMERIGROUP|COMMERCIAL,standard_charge|AMERIGROUP|COMMERCIAL|methodology,additional_payer_notes|AMERIGROUP|COMMERCIAL,standard_charge|AMERIGROUP|PEACHCARE|negotiated_dollar,standard_charge|AMERIGROUP|PEACHCARE|negotiated_percentage,standard_charge|AMERIGROUP|PEACHCARE|negotiated_algorithm,estimated_amount|AMERIGROUP|PEACHCARE,standard_charge|AMERIGROUP|PEACHCARE|methodology,additional_payer_notes|AMERIGROUP|PEACHCARE,standard_charge|ANTHEM|HMO|negotiated_dollar,standard_charge|ANTHEM|HMO|negotiated_percentage,standard_charge|ANTHEM|HMO|negotiated_algorithm,estimated_amount|ANTHEM|HMO,standard_charge|ANTHEM|HMO|methodology,additional_payer_notes|ANTHEM|HMO,standard_charge|ANTHEM|POS|negotiated_dollar,standard_charge|ANTHEM|POS|negotiated_percentage,standard_charge|ANTHEM|POS|negotiated_algorithm,estimated_amount|ANTHEM|POS,standard_charge|ANTHEM|POS|methodology,additional_payer_notes|ANTHEM|POS,standard_charge|ANTHEM|OPEN_ACCESS|negotiated_dollar,standard_charge|ANTHEM|OPEN_ACCESS|negotiated_percentage,standard_charge|ANTHEM|OPEN_ACCESS|negotiated_algorithm,estimated_amount|ANTHEM|OPEN_ACCESS,standard_charge|ANTHEM|OPEN_ACCESS|methodology,additional_payer_notes|ANTHEM|OPEN_ACCESS,standard_charge|ANTHEM|INDEMNITY|negotiated_dollar,standard_charge|ANTHEM|INDEMNITY|negotiated_percentage,standard_charge|ANTHEM|INDEMNITY|negotiated_algorithm,estimated_amount|ANTHEM|INDEMNITY,standard_charge|ANTHEM|INDEMNITY|methodology,additional_payer_notes|ANTHEM|INDEMNITY,standard_charge|ANTHEM|PAR|negotiated_dollar,standard_charge|ANTHEM|PAR|negotiated_percentage,standard_charge|ANTHEM|PAR|negotiated_algorithm,estimated_amount|ANTHEM|PAR,standard_charge|ANTHEM|PAR|methodology,additional_payer_notes|ANTHEM|PAR,standard_charge|ANTHEM|PATHWAY|negotiated_dollar,standard_charge|ANTHEM|PATHWAY|negotiated_percentage,standard_charge|ANTHEM|PATHWAY|negotiated_algorithm,estimated_amount|ANTHEM|PATHWAY,standard_charge|ANTHEM|PATHWAY|methodology,additional_payer_notes|ANTHEM|PATHWAY,standard_charge|ANTHEM|PPO|negotiated_dollar,standard_charge|ANTHEM|PPO|negotiated_percentage,standard_charge|ANTHEM|PPO|negotiated_algorithm,estimated_amount|ANTHEM|PPO,standard_charge|ANTHEM|PPO|methodology,additional_payer_notes|ANTHEM|PPO,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_HMO|negotiated_dollar,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_HMO|negotiated_percentage,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_HMO|negotiated_algorithm,estimated_amount|ANTHEM|MEDICARE_ADVANTAGE_HMO,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_HMO|methodology,additional_payer_notes|ANTHEM|MEDICARE_ADVANTAGE_HMO,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_PPO|negotiated_dollar,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_PPO|negotiated_percentage,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_PPO|negotiated_algorithm,estimated_amount|ANTHEM|MEDICARE_ADVANTAGE_PPO,standard_charge|ANTHEM|MEDICARE_ADVANTAGE_PPO|methodology,additional_payer_notes|ANTHEM|MEDICARE_ADVANTAGE_PPO,standard_charge|CARESOURCE|COMMERCIAL|negotiated_dollar,standard_charge|CARESOURCE|COMMERCIAL|negotiated_percentage,standard_charge|CARESOURCE|COMMERCIAL|negotiated_algorithm,estimated_amount|CARESOURCE|COMMERCIAL,standard_charge|CARESOURCE|COMMERCIAL|methodology,additional_payer_notes|CARESOURCE|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|HUMANA|HMO|negotiated_dollar,standard_charge|HUMANA|HMO|negotiated_percentage,standard_charge|HUMANA|HMO|negotiated_algorithm,estimated_amount|HUMANA|HMO,standard_charge|HUMANA|HMO|methodology,additional_payer_notes|HUMANA|HMO,standard_charge|HUMANA|POS|negotiated_dollar,standard_charge|HUMANA|POS|negotiated_percentage,standard_charge|HUMANA|POS|negotiated_algorithm,estimated_amount|HUMANA|POS,standard_charge|HUMANA|POS|methodology,additional_payer_notes|HUMANA|POS,standard_charge|HUMANA|MEDICARE_PPO|negotiated_dollar,standard_charge|HUMANA|MEDICARE_PPO|negotiated_percentage,standard_charge|HUMANA|MEDICARE_PPO|negotiated_algorithm,estimated_amount|HUMANA|MEDICARE_PPO,standard_charge|HUMANA|MEDICARE_PPO|methodology,additional_payer_notes|HUMANA|MEDICARE_PPO,standard_charge|HUMANA|PPO_EPO|negotiated_dollar,standard_charge|HUMANA|PPO_EPO|negotiated_percentage,standard_charge|HUMANA|PPO_EPO|negotiated_algorithm,estimated_amount|HUMANA|PPO_EPO,standard_charge|HUMANA|PPO_EPO|methodology,additional_payer_notes|HUMANA|PPO_EPO,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_dollar,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_percentage,standard_charge|MULTIPLAN|COMMERCIAL|negotiated_algorithm,estimated_amount|MULTIPLAN|COMMERCIAL,standard_charge|MULTIPLAN|COMMERCIAL|methodology,additional_payer_notes|MULTIPLAN|COMMERCIAL,standard_charge|UHC|HMO|negotiated_dollar,standard_charge|UHC|HMO|negotiated_percentage,standard_charge|UHC|HMO|negotiated_algorithm,estimated_amount|UHC|HMO,standard_charge|UHC|HMO|methodology,additional_payer_notes|UHC|HMO,standard_charge|UHC|PPO|negotiated_dollar,standard_charge|UHC|PPO|negotiated_percentage,standard_charge|UHC|PPO|negotiated_algorithm,estimated_amount|UHC|PPO,standard_charge|UHC|PPO|methodology,additional_payer_notes|UHC|PPO,standard_charge|UHC|MEDICARE_HMO|negotiated_dollar,standard_charge|UHC|MEDICARE_HMO|negotiated_percentage,standard_charge|UHC|MEDICARE_HMO|negotiated_algorithm,estimated_amount|UHC|MEDICARE_HMO,standard_charge|UHC|MEDICARE_HMO|methodology,additional_payer_notes|UHC|MEDICARE_HMO,standard_charge|UHC|MEDICARE_PPO|negotiated_dollar,standard_charge|UHC|MEDICARE_PPO|negotiated_percentage,standard_charge|UHC|MEDICARE_PPO|negotiated_algorithm,estimated_amount|UHC|MEDICARE_PPO,standard_charge|UHC|MEDICARE_PPO|methodology,additional_payer_notes|UHC|MEDICARE_PPO,standard_charge|WELLCARE|MEDICAID|negotiated_dollar,standard_charge|WELLCARE|MEDICAID|negotiated_percentage,standard_charge|WELLCARE|MEDICAID|negotiated_algorithm,estimated_amount|WELLCARE|MEDICAID,standard_charge|WELLCARE|MEDICAID|methodology,additional_payer_notes|WELLCARE|MEDICAID,standard_charge|WELLCARE|MEDICARE|negotiated_dollar,standard_charge|WELLCARE|MEDICARE|negotiated_percentage,standard_charge|WELLCARE|MEDICARE|negotiated_algorithm,estimated_amount|WELLCARE|MEDICARE,standard_charge|WELLCARE|MEDICARE|methodology,additional_payer_notes|WELLCARE|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
COVID IgG & COVID IgM,129619,CDM,300,RC,86769,HCPCS,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,161.02,
COVID IgM,129620,CDM,300,RC,86769,HCPCS,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,161.02,
COVID IgG,129621,CDM,300,RC,86769,HCPCS,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,100.43,
CBC WITH MANUAL DIFF,129622,CDM,300,RC,85027,HCPCS,outpatient,,,129.13,64.57,,90.39,70,,72.312,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,100.72,78,,80.576,percent of total billed charges,78% of total billed charges for outpatient setting,90.39,70,,72.312,percent of total billed charges,70% of total billed charges for outpatient setting,90.39,70,,72.312,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.85,75,,77.48,percent of total billed charges,75% of total billed charges for outpatient setting,107.18,83,,85.744,percent of total billed charges,83% of total billed charges for outpatient setting,64.57,50,,51.656,percent of total billed charges,50% of total billed charges for outpatient setting,64.57,50,,51.656,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,107.18,
CBCMD,129623,CDM,300,RC,85027,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,107.07,
COVID ANTIGEN,129624,CDM,300,RC,87426,HCPCS,outpatient,,,102.12,51.06,,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,35.33,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.65,78,,63.72,percent of total billed charges,78% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,83,,67.808,percent of total billed charges,83% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.33,84.76,
OB CLINIC VISIT,200001,CDM,510,RC,,,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
RECOVERY ROOM,200003,CDM,710,RC,,,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
NON STRESS TEST,200007,CDM,720,RC,59025,HCPCS,outpatient,,,261,130.5,,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,171.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,100.22,38.4,,80.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.22,38.4,,80.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.35,35,,73.08,percent of total billed charges,35% of total billed charges for outpatient setting,203.58,78,,162.864,percent of total billed charges,78% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,216.63,83,,173.304,percent of total billed charges,83% of total billed charges for outpatient setting,130.5,50,,104.4,percent of total billed charges,50% of total billed charges for outpatient setting,130.5,50,,104.4,percent of total billed charges,50% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.22,39.17,,81.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.35,216.63,
AMNI HOOKS,200008,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
FEMALE CATH KIT,200034,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
FOOEY CATHETERS,200039,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
INTRAN IUP CATHETER,200048,CDM,272,RC,,,outpatient,,,175,87.5,,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.25,35,,49,percent of total billed charges,35% of total billed charges for outpatient setting,136.5,78,,109.2,percent of total billed charges,78% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,145.25,83,,116.2,percent of total billed charges,83% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.54,39.17,,54.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,61.25,145.25,
VACUUM KITS PINK,200061,CDM,270,RC,,,outpatient,,,210,105,,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,35,,58.8,percent of total billed charges,35% of total billed charges for outpatient setting,163.8,78,,131.04,percent of total billed charges,78% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,83,,139.44,percent of total billed charges,83% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.25,39.17,,65.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.5,174.3,
VACUUM KITS BLUE,200062,CDM,270,RC,,,outpatient,,,210,105,,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,35,,58.8,percent of total billed charges,35% of total billed charges for outpatient setting,163.8,78,,131.04,percent of total billed charges,78% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,83,,139.44,percent of total billed charges,83% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.25,39.17,,65.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.5,174.3,
RED RUBBER CATHETER,200075,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
SPIRAL SCALP ELECTRO,200081,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
STERILE 2X2,200082,CDM,272,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
STERILE 4X4,200083,CDM,272,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
VAGINAL DEL PACK,200100,CDM,270,RC,,,outpatient,,,230,115,,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.5,35,,64.4,percent of total billed charges,35% of total billed charges for outpatient setting,179.4,78,,143.52,percent of total billed charges,78% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,190.9,83,,152.72,percent of total billed charges,83% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.09,39.17,,72.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.5,190.9,
YANKAUER SUCTION TIP,200101,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
OXYTOCIN CHALLENGE T,200112,CDM,720,RC,,,outpatient,,,584,292,,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.4,35,,163.52,percent of total billed charges,35% of total billed charges for outpatient setting,455.52,78,,364.416,percent of total billed charges,78% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,484.72,83,,387.776,percent of total billed charges,83% of total billed charges for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.75,39.17,,183,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,204.4,1167,
CONTRACTION STRESS T,200113,CDM,720,RC,,,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.45,1167,
BREAST PUMP,200122,CDM,270,RC,,,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.73,38.4,,20.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.73,38.4,,20.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.45,35,,18.76,percent of total billed charges,35% of total billed charges for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.24,39.17,,20.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.45,55.61,
INJECTION IM ANTIOBIOTIC,200126,CDM,720,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM STEROID,200127,CDM,720,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM THERAPEUTIC,200128,CDM,940,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,212,
INJECTION IM TRANQUALIZER,200129,CDM,720,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
CATHETER UNILATERAL,200130,CDM,720,RC,36000,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
INJECTION IV ANTIBIOTIC,200132,CDM,720,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV THERAPUTIC,200133,CDM,720,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
IV INFUSION IST HOUR,200134,CDM,720,RC,96365,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,293.82,
IV INFUSION EACH ADD L HOUR,200135,CDM,720,RC,96366,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,50.63,
CATHERIZATION SIMPLE,200136,CDM,720,RC,51702,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
POSTPARTUM CARE ONLY,200137,CDM,720,RC,59430,HCPCS,outpatient,,,849,424.5,,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,326.02,38.4,,260.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,326.02,38.4,,260.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,636.75,75,,509.4,percent of total billed charges,75% of total billed charges for outpatient setting,636.75,75,,509.4,percent of total billed charges,75% of total billed charges for outpatient setting,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,636.75,75,,509.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,297.15,35,,237.72,percent of total billed charges,35% of total billed charges for outpatient setting,662.22,78,,529.776,percent of total billed charges,78% of total billed charges for outpatient setting,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,594.3,70,,475.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,636.75,75,,509.4,percent of total billed charges,75% of total billed charges for outpatient setting,704.67,83,,563.736,percent of total billed charges,83% of total billed charges for outpatient setting,424.5,50,,339.6,percent of total billed charges,50% of total billed charges for outpatient setting,424.5,50,,339.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,332.54,39.17,,266.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,297.15,704.67,
CHILD BIRTH CLASS,210000,CDM,942,RC,S9442,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,212,
OB ICU (ANTEPARTUM),210002,CDM,720,RC,,,outpatient,,,501,250.5,,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.38,38.4,,153.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.38,38.4,,153.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175.35,35,,140.28,percent of total billed charges,35% of total billed charges for outpatient setting,390.78,78,,312.624,percent of total billed charges,78% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,415.83,83,,332.664,percent of total billed charges,83% of total billed charges for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196.23,39.17,,156.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,175.35,1167,
OB ICU (POST PARTUM),210003,CDM,720,RC,,,outpatient,,,501,250.5,,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.38,38.4,,153.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.38,38.4,,153.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175.35,35,,140.28,percent of total billed charges,35% of total billed charges for outpatient setting,390.78,78,,312.624,percent of total billed charges,78% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,350.7,70,,280.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.75,75,,300.6,percent of total billed charges,75% of total billed charges for outpatient setting,415.83,83,,332.664,percent of total billed charges,83% of total billed charges for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,1167,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196.23,39.17,,156.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,175.35,1167,
LAP SPONGES,210035,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
MONITOR BELT,210037,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
SUTURE RAPIDE 2.0 36,210041,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
POLY SUTURE 2.0 GS22,210042,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SUTURE REMOVAL KIT,210043,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
DOUBLE SET UP,210046,CDM,270,RC,,,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.05,185.09,
RECOVERY ROOM 15 MIN,210047,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
SUTURE RAPIDE 4.0 18,210049,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
POLY SUTURE 3.0 27,210054,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SUTURE RAPIDE 3.0 36,210055,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
POLY SUTURE 2.0 GS21,210056,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
EVALUATION/ MANAGEMENT LEVEL 1,210062,CDM,940,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,212,
EVALUATION/ MANAGEMENT LEVEL 2,210063,CDM,940,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,212,
EVALUATION/ MANAGEMENT LEVEL 3,210064,CDM,940,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,212,
EVALUATION/ MANAGEMENT LEVEL 4,210065,CDM,940,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
EVALUATION/ MANAGEMENT LEVEL 5,210066,CDM,940,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
EVALUATION/ MANAGEMENT LEVEL 1,210067,CDM,940,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,212,
EVALUATION/ MANAGEMENT LEVEL 2,210068,CDM,940,RC,99212,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,212,
EVALUATION/ MANAGEMENT LEVEL 3,210069,CDM,940,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,212,
EVALUATION/ MANAGEMENT LEVEL 4,210070,CDM,940,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,212,
EVALUATION/ MANAGEMENT LEVEL 5,210071,CDM,940,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
CATH FOLEY TRAY,220004,CDM,270,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
PACU 1ST HR,220046,CDM,710,RC,,,outpatient,,,306,153,,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.5,38.4,,94,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.5,38.4,,94,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,229.5,75,,183.6,percent of total billed charges,75% of total billed charges for outpatient setting,229.5,75,,183.6,percent of total billed charges,75% of total billed charges for outpatient setting,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,229.5,75,,183.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.1,35,,85.68,percent of total billed charges,35% of total billed charges for outpatient setting,238.68,78,,190.944,percent of total billed charges,78% of total billed charges for outpatient setting,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,214.2,70,,171.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.5,75,,183.6,percent of total billed charges,75% of total billed charges for outpatient setting,253.98,83,,203.184,percent of total billed charges,83% of total billed charges for outpatient setting,153,50,,122.4,percent of total billed charges,50% of total billed charges for outpatient setting,153,50,,122.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.85,39.17,,95.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,107.1,253.98,
PACU EA ADD 1/2 HOUR,220048,CDM,710,RC,,,outpatient,,,232,116,,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.2,35,,64.96,percent of total billed charges,35% of total billed charges for outpatient setting,180.96,78,,144.768,percent of total billed charges,78% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.56,83,,154.048,percent of total billed charges,83% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.87,39.17,,72.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.2,192.56,
MEDELA DBL BRST PUMP,220058,CDM,270,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
BLOOD WARMING TUBING,220059,CDM,270,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
I V START KIT,220062,CDM,260,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,212,
ANGIO CATH 20,220063,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
ANGIO CATH 18,220064,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
ULTRASOUND LIMITED,220069,CDM,402,RC,76815,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
DELIVERY VAGINAL,220070,CDM,722,RC,59400,HCPCS,outpatient,,,5368,2684,,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2061.31,38.4,,1649.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2061.31,38.4,,1649.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,4026,75,,3220.8,percent of total billed charges,75% of total billed charges for outpatient setting,4026,75,,3220.8,percent of total billed charges,75% of total billed charges for outpatient setting,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,4026,75,,3220.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1878.8,35,,1503.04,percent of total billed charges,35% of total billed charges for outpatient setting,4187.04,78,,3349.632,percent of total billed charges,78% of total billed charges for outpatient setting,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,3757.6,70,,3006.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4026,75,,3220.8,percent of total billed charges,75% of total billed charges for outpatient setting,4455.44,83,,3564.352,percent of total billed charges,83% of total billed charges for outpatient setting,2684,50,,2147.2,percent of total billed charges,50% of total billed charges for outpatient setting,2684,50,,2147.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2102.54,39.17,,1682.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1878.8,4455.44,
ULTRASOUND REPEAT,220073,CDM,402,RC,76816,HCPCS,outpatient,,,283,141.5,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.05,35,,79.24,percent of total billed charges,35% of total billed charges for outpatient setting,220.74,78,,176.592,percent of total billed charges,78% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,234.89,83,,187.912,percent of total billed charges,83% of total billed charges for outpatient setting,452.8,100,,,case rate,100% UHC case rate for outpatient setting,452.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.84,39.17,,88.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,452.8,
ULTRASOUND TVS,220075,CDM,402,RC,76830,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
PRECIP PACK,220077,CDM,270,RC,,,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.9,78.02,
KERMA WRAP 6-INCH,220079,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
SUTURE POLYSORB 3-0 GS21,220085,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SUTURE POLYSORB 3-0 GS22,220086,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SUTURE POLYSORB 4-0 P12,220087,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SUTURE POLYSORB 0,220088,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
PAD LEG PLATE ATTACHMENT,220095,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
I-D SMALL ABSCESS,230000,CDM,360,RC,10060,HCPCS,outpatient,,,329,164.5,,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,35,,92.12,percent of total billed charges,35% of total billed charges for outpatient setting,256.62,78,,205.296,percent of total billed charges,78% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,273.07,83,,218.456,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.87,39.17,,103.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,659,
EXCISION SIMPLE HEMORRHOID,230001,CDM,360,RC,46220,HCPCS,outpatient,,,2923,1461.5,,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1023.05,35,,818.44,percent of total billed charges,35% of total billed charges for outpatient setting,2279.94,78,,1823.952,percent of total billed charges,78% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2426.09,83,,1940.872,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1144.88,39.17,,915.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,2426.09,
I-D PILONIDAL CYST,230002,CDM,360,RC,10080,HCPCS,outpatient,,,329,164.5,,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,35,,92.12,percent of total billed charges,35% of total billed charges for outpatient setting,256.62,78,,205.296,percent of total billed charges,78% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,273.07,83,,218.456,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.87,39.17,,103.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,1452,
TRANSFUSION BLOOD,230003,CDM,391,RC,36430,HCPCS,outpatient,,,587,293.5,,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,225.41,38.4,,180.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,225.41,38.4,,180.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,440.25,75,,352.2,percent of total billed charges,75% of total billed charges for outpatient setting,440.25,75,,352.2,percent of total billed charges,75% of total billed charges for outpatient setting,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,440.25,75,,352.2,percent of total billed charges,75% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.45,35,,164.36,percent of total billed charges,35% of total billed charges for outpatient setting,457.86,78,,366.288,percent of total billed charges,78% of total billed charges for outpatient setting,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,410.9,70,,328.72,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,440.25,75,,352.2,percent of total billed charges,75% of total billed charges for outpatient setting,487.21,83,,389.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.92,39.17,,183.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.45,487.21,
I-D VULVA OR PERINEAL,230004,CDM,360,RC,56405,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,275.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,659,
EXTERNAL CEPHALIC VERSION W/WO,230005,CDM,722,RC,59412,HCPCS,outpatient,,,2830,1415,,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,35,,792.4,percent of total billed charges,35% of total billed charges for outpatient setting,2207.4,78,,1765.92,percent of total billed charges,78% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2348.9,83,,1879.12,percent of total billed charges,83% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1108.45,39.17,,886.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,2685.48,
VAGINAL DELIVERY ONLY,230006,CDM,722,RC,59409,HCPCS,outpatient,,,2830,1415,,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,35,,792.4,percent of total billed charges,35% of total billed charges for outpatient setting,2207.4,78,,1765.92,percent of total billed charges,78% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2348.9,83,,1879.12,percent of total billed charges,83% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1108.45,39.17,,886.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,2685.48,
VAGINAL DELIVERY INCLUDING POS,230007,CDM,722,RC,59410,HCPCS,outpatient,,,2494,1247,,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,957.7,38.4,,766.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,957.7,38.4,,766.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,1870.5,75,,1496.4,percent of total billed charges,75% of total billed charges for outpatient setting,1870.5,75,,1496.4,percent of total billed charges,75% of total billed charges for outpatient setting,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,1870.5,75,,1496.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,872.9,35,,698.32,percent of total billed charges,35% of total billed charges for outpatient setting,1945.32,78,,1556.256,percent of total billed charges,78% of total billed charges for outpatient setting,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,1745.8,70,,1396.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1870.5,75,,1496.4,percent of total billed charges,75% of total billed charges for outpatient setting,2070.02,83,,1656.016,percent of total billed charges,83% of total billed charges for outpatient setting,1247,50,,997.6,percent of total billed charges,50% of total billed charges for outpatient setting,1247,50,,997.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,976.85,39.17,,781.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,872.9,2070.02,
DELIVERY OF PLACENTA ONLY,230008,CDM,722,RC,59414,HCPCS,outpatient,,,2830,1415,,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1086.72,38.4,,869.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,35,,792.4,percent of total billed charges,35% of total billed charges for outpatient setting,2207.4,78,,1765.92,percent of total billed charges,78% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,1981,70,,1584.8,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2122.5,75,,1698,percent of total billed charges,75% of total billed charges for outpatient setting,2348.9,83,,1879.12,percent of total billed charges,83% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,1415,50,,1132,percent of total billed charges,50% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1108.45,39.17,,886.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990.5,2685.48,
VBAC,230009,CDM,722,RC,59610,HCPCS,outpatient,,,5655,2827.5,,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2171.52,38.4,,1737.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2171.52,38.4,,1737.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,4241.25,75,,3393,percent of total billed charges,75% of total billed charges for outpatient setting,4241.25,75,,3393,percent of total billed charges,75% of total billed charges for outpatient setting,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,4241.25,75,,3393,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1979.25,35,,1583.4,percent of total billed charges,35% of total billed charges for outpatient setting,4410.9,78,,3528.72,percent of total billed charges,78% of total billed charges for outpatient setting,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,3958.5,70,,3166.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4241.25,75,,3393,percent of total billed charges,75% of total billed charges for outpatient setting,4693.65,83,,3754.92,percent of total billed charges,83% of total billed charges for outpatient setting,2827.5,50,,2262,percent of total billed charges,50% of total billed charges for outpatient setting,2827.5,50,,2262,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2214.95,39.17,,1771.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1979.25,4693.65,
DRAINAGE OF PELVIC ADSESS TRAN,230010,CDM,360,RC,58823,HCPCS,outpatient,,,1930,965,,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,741.12,38.4,,592.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.12,38.4,,592.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,675.5,35,,540.4,percent of total billed charges,35% of total billed charges for outpatient setting,1505.4,78,,1204.32,percent of total billed charges,78% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1601.9,83,,1281.52,percent of total billed charges,83% of total billed charges for outpatient setting,965,50,,772,percent of total billed charges,50% of total billed charges for outpatient setting,965,50,,772,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,755.94,39.17,,604.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,675.5,1601.9,
INSERTION OF CERVICAL DIALATOR,230011,CDM,722,RC,59200,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,275.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,275.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,323.7,
BIOPSY OF VULVA PERINEUM,230012,CDM,360,RC,56605,HCPCS,outpatient,,,760,380,,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,690.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,291.84,38.4,,233.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,291.84,38.4,,233.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,570,75,,456,percent of total billed charges,75% of total billed charges for outpatient setting,570,75,,456,percent of total billed charges,75% of total billed charges for outpatient setting,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,570,75,,456,percent of total billed charges,75% of total billed charges for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,266,35,,212.8,percent of total billed charges,35% of total billed charges for outpatient setting,592.8,78,,474.24,percent of total billed charges,78% of total billed charges for outpatient setting,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,532,70,,425.6,percent of total billed charges,70% of total billed charges for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,570,75,,456,percent of total billed charges,75% of total billed charges for outpatient setting,630.8,83,,504.64,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,297.68,39.17,,238.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,266,1452,
IV HYDRATION EACH ADDL HOUR,230015,CDM,720,RC,96361,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,50.63,
IN/OUT CATH,230016,CDM,721,RC,51701,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
CIRCUMCISION,500001,CDM,723,RC,54150,HCPCS,outpatient,,,278,139,,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,1749.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,35,,77.84,percent of total billed charges,35% of total billed charges for outpatient setting,216.84,78,,173.472,percent of total billed charges,78% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,230.74,83,,184.592,percent of total billed charges,83% of total billed charges for outpatient setting,139,50,,111.2,percent of total billed charges,50% of total billed charges for outpatient setting,139,50,,111.2,percent of total billed charges,50% of total billed charges for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.89,39.17,,87.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,1749.58,
STERILE 2X2,500011,CDM,272,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
FEEDING TUBE 3FRX12,500016,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
PHOTOTHERAPY,500019,CDM,171,RC,96900,HCPCS,inpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for inpatient setting,,,,,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,724,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,105% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for inpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for inpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for inpatient setting,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39,75,,31.2,percent of total billed charges,75% of total billed charges for inpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for inpatient setting,,,,,other,100% UHC DRG for inpatient setting. See MS-DRG rows for rates,,,,,other,100% UHC DRG for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36.4,788,
BILI MASK,500020,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
STERILE 4X4,500022,CDM,272,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
SPECIAL CARE NURSERY,500023,CDM,171,RC,,,inpatient,,,445,222.5,,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for inpatient setting,,,,,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,724,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,724,100,,,per diem,100% Anthem per diem for nursery,788,100,,,per diem,100% Anthem per diem for nursery,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,105% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,347.1,78,,277.68,percent of total billed charges,78% of total billed charges for inpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for inpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for inpatient setting,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,333.75,75,,267,percent of total billed charges,75% of total billed charges for inpatient setting,369.35,83,,295.48,percent of total billed charges,83% of total billed charges for inpatient setting,,,,,other,100% UHC DRG for inpatient setting. See MS-DRG rows for rates,,,,,other,100% UHC DRG for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% GA Medicaid rates for inpatient setting. See MS-DRG rows for rates,,,,,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,311.5,788,
DISP BP CUFF 2,500027,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
CIRCUMCISION RESTRAI,500032,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
PEDI-CATH KIT,500034,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
STARTER SNS,500047,CDM,270,RC,,,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,53.12,
FEEDING TUBE 5 FRX15,500075,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
FEEDING TUBE 6.5X20,500076,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
DISP BP CUFF 3,500080,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
DISP BP CUFF 4,500081,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
HEARING TEST,500082,CDM,479,RC,92551,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.2,212,
EVAL/MAMAGEMENT LEVEL I EST PA,500083,CDM,761,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
EVAL/MAMAGEMENT LEVEL I NEW PA,500084,CDM,761,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
EVAL/MAMAGEMENT LEVEL 2 EST,500085,CDM,761,RC,99212,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
EVAL/MAMAGEMENT LEVEL 2 NEW,500086,CDM,761,RC,,,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,64.74,
SUPPLE NURSING SYS,500088,CDM,270,RC,,,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,53.12,
VENIPUNCTURE CHILD UNDER 3,500090,CDM,310,RC,36400,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
REMOVAL OF SKIN TAG,500091,CDM,360,RC,11200,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.75,35,,51.8,percent of total billed charges,35% of total billed charges for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.46,39.17,,57.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.75,659,
CORD CLAMP,510032,CDM,270,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
ANGIO CATH 24,520065,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
NEWBORN RESUSITATION,599963,CDM,480,RC,99465,HCPCS,outpatient,,,515,257.5,,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.25,35,,144.2,percent of total billed charges,35% of total billed charges for outpatient setting,401.7,78,,321.36,percent of total billed charges,78% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,427.45,83,,341.96,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.72,39.17,,161.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.25,559.04,
SURGERY FIRST HOUR,700010,CDM,360,RC,,,outpatient,,,613,306.5,,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,214.55,35,,171.64,percent of total billed charges,35% of total billed charges for outpatient setting,478.14,78,,382.512,percent of total billed charges,78% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,508.79,83,,407.032,percent of total billed charges,83% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240.1,39.17,,192.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,214.55,508.79,
"FOGARTY CATH., A & V",700015,CDM,278,RC,C1757,HCPCS,both,,,136,68,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136,70,,108.8,percent of total billed charges,70% of total billed charges for outpatient setting,136,70,,108.8,percent of total billed charges,70% of total billed charges for outpatient setting,136,70,,108.8,percent of total billed charges,70% of total billed charges for outpatient setting,136,75,,108.8,percent of total billed charges,75% of total billed charges for outpatient setting,136,75,,108.8,percent of total billed charges,75% of total billed charges for outpatient setting,136,70,,108.8,percent of total billed charges,70% of total billed charges for outpatient setting,136,75,,108.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.6,35,,38.08,percent of total billed charges,35% of total billed charges for outpatient setting,106.08,78,,84.864,percent of total billed charges,78% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.88,83,,90.304,percent of total billed charges,83% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.26,39.17,,42.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.6,136,
EVALUATION/ MANAGEMENT LEVEL 5,700017,CDM,761,RC,99205,HCPCS,outpatient,,,537,268.5,,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,206.21,38.4,,164.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.21,38.4,,164.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,402.75,75,,322.2,percent of total billed charges,75% of total billed charges for outpatient setting,402.75,75,,322.2,percent of total billed charges,75% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,402.75,75,,322.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.95,35,,150.36,percent of total billed charges,35% of total billed charges for outpatient setting,418.86,78,,335.088,percent of total billed charges,78% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,402.75,75,,322.2,percent of total billed charges,75% of total billed charges for outpatient setting,445.71,83,,356.568,percent of total billed charges,83% of total billed charges for outpatient setting,268.5,50,,214.8,percent of total billed charges,50% of total billed charges for outpatient setting,268.5,50,,214.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210.33,39.17,,168.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,187.95,445.71,
SURGERY EA ADD 15MIN,700020,CDM,360,RC,,,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.7,51.46,
"LOOPS, VESSEL, PK.",700036,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
FOGARTY BILIARY CATH,700039,CDM,278,RC,C1726,HCPCS,both,,,148,74,,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148,70,,118.4,percent of total billed charges,70% of total billed charges for outpatient setting,148,70,,118.4,percent of total billed charges,70% of total billed charges for outpatient setting,148,70,,118.4,percent of total billed charges,70% of total billed charges for outpatient setting,148,75,,118.4,percent of total billed charges,75% of total billed charges for outpatient setting,148,75,,118.4,percent of total billed charges,75% of total billed charges for outpatient setting,148,70,,118.4,percent of total billed charges,70% of total billed charges for outpatient setting,148,75,,118.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.8,35,,41.44,percent of total billed charges,35% of total billed charges for outpatient setting,115.44,78,,92.352,percent of total billed charges,78% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.84,83,,98.272,percent of total billed charges,83% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.97,39.17,,46.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,51.8,148,
SURGICLIP-M-11,700052,CDM,270,RC,,,outpatient,,,209,104.5,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.26,38.4,,64.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.26,38.4,,64.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.15,35,,58.52,percent of total billed charges,35% of total billed charges for outpatient setting,163.02,78,,130.416,percent of total billed charges,78% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,173.47,83,,138.776,percent of total billed charges,83% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.87,39.17,,65.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.15,173.47,
CYSTO SET,700090,CDM,270,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
"RETENTION, NYLON",710033,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
"RETENTION, BRIDGE",710041,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
"STAPLER, SKIN, 25/35",710055,CDM,270,RC,,,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,90.47,
ENDOSCOPY RM CHARGE,710209,CDM,750,RC,,,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
ESOPHAGEAL DILAT.UN,710223,CDM,360,RC,,,outpatient,,,1773,886.5,,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,680.83,38.4,,544.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,680.83,38.4,,544.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,1329.75,75,,1063.8,percent of total billed charges,75% of total billed charges for outpatient setting,1329.75,75,,1063.8,percent of total billed charges,75% of total billed charges for outpatient setting,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,1329.75,75,,1063.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,620.55,35,,496.44,percent of total billed charges,35% of total billed charges for outpatient setting,1382.94,78,,1106.352,percent of total billed charges,78% of total billed charges for outpatient setting,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,1241.1,70,,992.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1329.75,75,,1063.8,percent of total billed charges,75% of total billed charges for outpatient setting,1471.59,83,,1177.272,percent of total billed charges,83% of total billed charges for outpatient setting,886.5,50,,709.2,percent of total billed charges,50% of total billed charges for outpatient setting,886.5,50,,709.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,694.45,39.17,,555.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,620.55,1471.59,
GASTROSTOMY TUBE,710231,CDM,270,RC,,,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56,35,,44.8,percent of total billed charges,35% of total billed charges for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.67,39.17,,50.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56,132.8,
SIGMOIDOSCOPY,711033,CDM,360,RC,,,outpatient,,,594,297,,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.1,38.4,,182.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.1,38.4,,182.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,445.5,75,,356.4,percent of total billed charges,75% of total billed charges for outpatient setting,445.5,75,,356.4,percent of total billed charges,75% of total billed charges for outpatient setting,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,445.5,75,,356.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,207.9,35,,166.32,percent of total billed charges,35% of total billed charges for outpatient setting,463.32,78,,370.656,percent of total billed charges,78% of total billed charges for outpatient setting,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,415.8,70,,332.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,445.5,75,,356.4,percent of total billed charges,75% of total billed charges for outpatient setting,493.02,83,,394.416,percent of total billed charges,83% of total billed charges for outpatient setting,297,50,,237.6,percent of total billed charges,50% of total billed charges for outpatient setting,297,50,,237.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.66,39.17,,186.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,207.9,493.02,
SIGMOIDOSCOPY & BX,711034,CDM,360,RC,,,outpatient,,,368,184,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141.31,38.4,,113.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,141.31,38.4,,113.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.8,35,,103.04,percent of total billed charges,35% of total billed charges for outpatient setting,287.04,78,,229.632,percent of total billed charges,78% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,305.44,83,,244.352,percent of total billed charges,83% of total billed charges for outpatient setting,184,50,,147.2,percent of total billed charges,50% of total billed charges for outpatient setting,184,50,,147.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.14,39.17,,115.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,128.8,305.44,
SIGMOIDOSCOPY & POLY,711035,CDM,360,RC,,,outpatient,,,368,184,,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141.31,38.4,,113.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,141.31,38.4,,113.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.8,35,,103.04,percent of total billed charges,35% of total billed charges for outpatient setting,287.04,78,,229.632,percent of total billed charges,78% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.6,70,,206.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276,75,,220.8,percent of total billed charges,75% of total billed charges for outpatient setting,305.44,83,,244.352,percent of total billed charges,83% of total billed charges for outpatient setting,184,50,,147.2,percent of total billed charges,50% of total billed charges for outpatient setting,184,50,,147.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.14,39.17,,115.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,128.8,305.44,
MINOR TRAY,711231,CDM,270,RC,,,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.7,51.46,
EGD DILITATION,715153,CDM,360,RC,,,outpatient,,,613,306.5,,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,214.55,35,,171.64,percent of total billed charges,35% of total billed charges for outpatient setting,478.14,78,,382.512,percent of total billed charges,78% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,508.79,83,,407.032,percent of total billed charges,83% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240.1,39.17,,192.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,214.55,508.79,
U/S GUIDED CYST ASPIRATION,715154,CDM,360,RC,19000,HCPCS,outpatient,,,846,423,,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,35,,236.88,percent of total billed charges,35% of total billed charges for outpatient setting,659.88,78,,527.904,percent of total billed charges,78% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,702.18,83,,561.744,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.36,39.17,,265.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,1452,
"DRAINS, J-P,FLAT EA",720000,CDM,270,RC,,,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,35,,21,percent of total billed charges,35% of total billed charges for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.38,39.17,,23.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.25,62.25,
"DRAIN KIT, J-P EA",720003,CDM,270,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
EVALUATION/ MANAGEMENT LEVEL 1,720480,CDM,761,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
EVALUATION/ MANAGEMENT LEVEL 1,720481,CDM,761,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
EVALUATION/ MANAGEMENT LEVEL 2,720482,CDM,761,RC,99212,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
EVALUATION/ MANAGEMENT LEVEL 2,720483,CDM,761,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,106.24,
EVALUATION/ MANAGEMENT LEVEL 3,720484,CDM,761,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
EVALUATION/ MANAGEMENT LEVEL 3,720485,CDM,761,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
EVALUATION/ MANAGEMENT LEVEL 4,720486,CDM,761,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
EVALUATION/ MANAGEMENT LEVEL 4,720487,CDM,761,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
EVALUATION/ MANAGEMENT LEVEL 5,720488,CDM,761,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
EVALUATION/ MANAGEMENT LEVEL 5,720489,CDM,761,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
PORTA CATH NEEDLE,722255,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
PORTA CATH NEEDLE EX,722256,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
"PORT-A-CATH TRAY,KIT",722333,CDM,278,RC,C1788,HCPCS,both,,,797,398.5,,557.9,70,,446.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,306.05,38.4,,244.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,306.05,38.4,,244.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,557.9,70,,446.32,percent of total billed charges,70% of billed charges for implant carveouts,557.9,70,,446.32,percent of total billed charges,70% of billed charges for implant carveouts,557.9,70,,446.32,percent of total billed charges,70% of billed charges for implant carveouts,637.6,80,,510.08,percent of total billed charges,80% of billed charges for implant carveouts,637.6,80,,510.08,percent of total billed charges,80% of billed charges for implant carveouts,557.9,70,,446.32,percent of total billed charges,70% of billed charges for implant carveouts,637.6,80,,510.08,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,278.95,35,,223.16,percent of total billed charges,35% of total billed charges for outpatient setting,621.66,78,,497.328,percent of total billed charges,78% of total billed charges for outpatient setting,557.9,70,,446.32,percent of total billed charges,70% of total billed charges for outpatient setting,557.9,70,,446.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,597.75,75,,478.2,percent of total billed charges,75% of total billed charges for outpatient setting,661.51,83,,529.208,percent of total billed charges,83% of total billed charges for outpatient setting,398.5,50,,318.8,percent of total billed charges,50% of total billed charges for outpatient setting,398.5,50,,318.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,312.17,39.17,,249.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,278.95,661.51,
NERVE LOCATOR,730006,CDM,270,RC,,,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.4,69.72,
ULTIMA BITE BLOCK,730019,CDM,270,RC,,,outpatient,,,16.8,8.4,,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.45,38.4,,5.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.45,38.4,,5.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,75,,10.08,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,75,,10.08,percent of total billed charges,75% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,75,,10.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,35,,4.704,percent of total billed charges,35% of total billed charges for outpatient setting,13.1,78,,10.48,percent of total billed charges,78% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.6,75,,10.08,percent of total billed charges,75% of total billed charges for outpatient setting,13.94,83,,11.152,percent of total billed charges,83% of total billed charges for outpatient setting,8.4,50,,6.72,percent of total billed charges,50% of total billed charges for outpatient setting,8.4,50,,6.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.58,39.17,,5.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.88,13.94,
SCLEROTHERAPY NEEDLE,730020,CDM,270,RC,,,outpatient,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49,35,,39.2,percent of total billed charges,35% of total billed charges for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.84,39.17,,43.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49,116.2,
MESH-PROLENE PMII 3X6,731316,CDM,278,RC,C1781,HCPCS,both,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,75,,78.4,percent of total billed charges,75% of total billed charges for outpatient setting,98,75,,78.4,percent of total billed charges,75% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,75,,78.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,98,
PERC. INTRODUCER KIT,733321,CDM,270,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
SURGERY CAT I 1HR,740002,CDM,360,RC,,,outpatient,,,472,236,,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.2,35,,132.16,percent of total billed charges,35% of total billed charges for outpatient setting,368.16,78,,294.528,percent of total billed charges,78% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,391.76,83,,313.408,percent of total billed charges,83% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.88,39.17,,147.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,165.2,391.76,
SURGERY CAT I 15 MIN,740003,CDM,360,RC,,,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21,49.8,
SURGERY CAT II 1HR,740004,CDM,360,RC,,,outpatient,,,563,281.5,,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.05,35,,157.64,percent of total billed charges,35% of total billed charges for outpatient setting,439.14,78,,351.312,percent of total billed charges,78% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,467.29,83,,373.832,percent of total billed charges,83% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.51,39.17,,176.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,197.05,467.29,
SURGERY CAT II 15MIN,740005,CDM,360,RC,,,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.85,35,,19.88,percent of total billed charges,35% of total billed charges for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.81,39.17,,22.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.85,58.93,
SURGERY CAT III 1HR,740006,CDM,360,RC,,,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,229.25,543.65,
SURGERY CAT III 15MI,740007,CDM,360,RC,,,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.05,68.89,
SURGERY CAT IV 1HR,740008,CDM,360,RC,,,outpatient,,,717,358.5,,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.95,35,,200.76,percent of total billed charges,35% of total billed charges for outpatient setting,559.26,78,,447.408,percent of total billed charges,78% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,595.11,83,,476.088,percent of total billed charges,83% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,280.84,39.17,,224.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,250.95,595.11,
SURGERY CAT IV 15MIN,740009,CDM,360,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
SURGERY CAT V 1HR,740010,CDM,360,RC,,,outpatient,,,778,389,,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,298.75,38.4,,239,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,298.75,38.4,,239,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,583.5,75,,466.8,percent of total billed charges,75% of total billed charges for outpatient setting,583.5,75,,466.8,percent of total billed charges,75% of total billed charges for outpatient setting,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,583.5,75,,466.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,272.3,35,,217.84,percent of total billed charges,35% of total billed charges for outpatient setting,606.84,78,,485.472,percent of total billed charges,78% of total billed charges for outpatient setting,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,544.6,70,,435.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,583.5,75,,466.8,percent of total billed charges,75% of total billed charges for outpatient setting,645.74,83,,516.592,percent of total billed charges,83% of total billed charges for outpatient setting,389,50,,311.2,percent of total billed charges,50% of total billed charges for outpatient setting,389,50,,311.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,304.73,39.17,,243.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,272.3,645.74,
SURGERY CAT V 15 MIN,740011,CDM,360,RC,,,outpatient,,,272,136,,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.45,38.4,,83.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.45,38.4,,83.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,204,75,,163.2,percent of total billed charges,75% of total billed charges for outpatient setting,204,75,,163.2,percent of total billed charges,75% of total billed charges for outpatient setting,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,204,75,,163.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.2,35,,76.16,percent of total billed charges,35% of total billed charges for outpatient setting,212.16,78,,169.728,percent of total billed charges,78% of total billed charges for outpatient setting,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,190.4,70,,152.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204,75,,163.2,percent of total billed charges,75% of total billed charges for outpatient setting,225.76,83,,180.608,percent of total billed charges,83% of total billed charges for outpatient setting,136,50,,108.8,percent of total billed charges,50% of total billed charges for outpatient setting,136,50,,108.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.54,39.17,,85.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,95.2,225.76,
APPENDECTOMY L-SCOPY,744333,CDM,360,RC,,,outpatient,,,7171,3585.5,,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2753.66,38.4,,2202.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2753.66,38.4,,2202.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,5378.25,75,,4302.6,percent of total billed charges,75% of total billed charges for outpatient setting,5378.25,75,,4302.6,percent of total billed charges,75% of total billed charges for outpatient setting,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,5378.25,75,,4302.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2509.85,35,,2007.88,percent of total billed charges,35% of total billed charges for outpatient setting,5593.38,78,,4474.704,percent of total billed charges,78% of total billed charges for outpatient setting,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,5019.7,70,,4015.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5378.25,75,,4302.6,percent of total billed charges,75% of total billed charges for outpatient setting,5951.93,83,,4761.544,percent of total billed charges,83% of total billed charges for outpatient setting,3585.5,50,,2868.4,percent of total billed charges,50% of total billed charges for outpatient setting,3585.5,50,,2868.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2808.73,39.17,,2246.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2509.85,5951.93,
DIAG. LAPARASCOPY,744444,CDM,360,RC,,,outpatient,,,5591,2795.5,,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2146.94,38.4,,1717.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2146.94,38.4,,1717.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,4193.25,75,,3354.6,percent of total billed charges,75% of total billed charges for outpatient setting,4193.25,75,,3354.6,percent of total billed charges,75% of total billed charges for outpatient setting,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,4193.25,75,,3354.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1956.85,35,,1565.48,percent of total billed charges,35% of total billed charges for outpatient setting,4360.98,78,,3488.784,percent of total billed charges,78% of total billed charges for outpatient setting,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,3913.7,70,,3130.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4193.25,75,,3354.6,percent of total billed charges,75% of total billed charges for outpatient setting,4640.53,83,,3712.424,percent of total billed charges,83% of total billed charges for outpatient setting,2795.5,50,,2236.4,percent of total billed charges,50% of total billed charges for outpatient setting,2795.5,50,,2236.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2189.88,39.17,,1751.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1956.85,4640.53,
BRONCHOSCOPY & BX,750001,CDM,360,RC,,,outpatient,,,1862,931,,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,715.01,38.4,,572.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,715.01,38.4,,572.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,1396.5,75,,1117.2,percent of total billed charges,75% of total billed charges for outpatient setting,1396.5,75,,1117.2,percent of total billed charges,75% of total billed charges for outpatient setting,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,1396.5,75,,1117.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,651.7,35,,521.36,percent of total billed charges,35% of total billed charges for outpatient setting,1452.36,78,,1161.888,percent of total billed charges,78% of total billed charges for outpatient setting,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,1303.4,70,,1042.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1396.5,75,,1117.2,percent of total billed charges,75% of total billed charges for outpatient setting,1545.46,83,,1236.368,percent of total billed charges,83% of total billed charges for outpatient setting,931,50,,744.8,percent of total billed charges,50% of total billed charges for outpatient setting,931,50,,744.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,729.31,39.17,,583.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,651.7,1545.46,
BRONCHOSCOPY-DIAGNOSTIC,750010,CDM,360,RC,31622,HCPCS,outpatient,,,2742,1371,,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,1457.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1052.93,38.4,,842.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1052.93,38.4,,842.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,2056.5,75,,1645.2,percent of total billed charges,75% of total billed charges for outpatient setting,2056.5,75,,1645.2,percent of total billed charges,75% of total billed charges for outpatient setting,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,2056.5,75,,1645.2,percent of total billed charges,75% of total billed charges for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,959.7,35,,767.76,percent of total billed charges,35% of total billed charges for outpatient setting,2138.76,78,,1711.008,percent of total billed charges,78% of total billed charges for outpatient setting,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,1919.4,70,,1535.52,percent of total billed charges,70% of total billed charges for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2056.5,75,,1645.2,percent of total billed charges,75% of total billed charges for outpatient setting,2275.86,83,,1820.688,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1073.99,39.17,,859.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,959.7,2275.86,
SURG-I-PAWS,750011,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
DERMATONE MESHER,750061,CDM,270,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
"ENDOSCOPY, UPPER/DX",750112,CDM,360,RC,,,outpatient,,,2280.6,1140.3,,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,875.75,38.4,,700.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,875.75,38.4,,700.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,1710.45,75,,1368.36,percent of total billed charges,75% of total billed charges for outpatient setting,1710.45,75,,1368.36,percent of total billed charges,75% of total billed charges for outpatient setting,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,1710.45,75,,1368.36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,798.21,35,,638.568,percent of total billed charges,35% of total billed charges for outpatient setting,1778.87,78,,1423.096,percent of total billed charges,78% of total billed charges for outpatient setting,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,1596.42,70,,1277.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1710.45,75,,1368.36,percent of total billed charges,75% of total billed charges for outpatient setting,1892.9,83,,1514.32,percent of total billed charges,83% of total billed charges for outpatient setting,1140.3,50,,912.24,percent of total billed charges,50% of total billed charges for outpatient setting,1140.3,50,,912.24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.27,39.17,,714.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,798.21,1892.9,
"ENDOSCOPY, UPPER/BX",750113,CDM,360,RC,,,outpatient,,,1927,963.5,,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,739.97,38.4,,591.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,739.97,38.4,,591.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges for outpatient setting,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges for outpatient setting,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,674.45,35,,539.56,percent of total billed charges,35% of total billed charges for outpatient setting,1503.06,78,,1202.448,percent of total billed charges,78% of total billed charges for outpatient setting,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,1348.9,70,,1079.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1445.25,75,,1156.2,percent of total billed charges,75% of total billed charges for outpatient setting,1599.41,83,,1279.528,percent of total billed charges,83% of total billed charges for outpatient setting,963.5,50,,770.8,percent of total billed charges,50% of total billed charges for outpatient setting,963.5,50,,770.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,754.77,39.17,,603.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,674.45,1599.41,
"ENDOSCOPY, UP REM FB",750114,CDM,360,RC,,,outpatient,,,2011,1005.5,,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,772.22,38.4,,617.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,772.22,38.4,,617.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,1508.25,75,,1206.6,percent of total billed charges,75% of total billed charges for outpatient setting,1508.25,75,,1206.6,percent of total billed charges,75% of total billed charges for outpatient setting,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,1508.25,75,,1206.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,703.85,35,,563.08,percent of total billed charges,35% of total billed charges for outpatient setting,1568.58,78,,1254.864,percent of total billed charges,78% of total billed charges for outpatient setting,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,1407.7,70,,1126.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1508.25,75,,1206.6,percent of total billed charges,75% of total billed charges for outpatient setting,1669.13,83,,1335.304,percent of total billed charges,83% of total billed charges for outpatient setting,1005.5,50,,804.4,percent of total billed charges,50% of total billed charges for outpatient setting,1005.5,50,,804.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,787.66,39.17,,630.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,703.85,1669.13,
PENROSE DRAINS 12,750120,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
FLEXILUM-OR LIGHT,750151,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
GIGLE SAW BLADE   EA,750160,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
"COLONOSCOPY, DX",750269,CDM,360,RC,,,outpatient,,,2396.8,1198.4,,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,920.37,38.4,,736.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,920.37,38.4,,736.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,1797.6,75,,1438.08,percent of total billed charges,75% of total billed charges for outpatient setting,1797.6,75,,1438.08,percent of total billed charges,75% of total billed charges for outpatient setting,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,1797.6,75,,1438.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,838.88,35,,671.104,percent of total billed charges,35% of total billed charges for outpatient setting,1869.5,78,,1495.6,percent of total billed charges,78% of total billed charges for outpatient setting,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,1677.76,70,,1342.208,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1797.6,75,,1438.08,percent of total billed charges,75% of total billed charges for outpatient setting,1989.34,83,,1591.472,percent of total billed charges,83% of total billed charges for outpatient setting,1198.4,50,,958.72,percent of total billed charges,50% of total billed charges for outpatient setting,1198.4,50,,958.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,938.78,39.17,,751.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,838.88,1989.34,
COLONOSCOPY & BX,750270,CDM,360,RC,,,outpatient,,,2875.6,1437.8,,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1104.23,38.4,,883.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1104.23,38.4,,883.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,2156.7,75,,1725.36,percent of total billed charges,75% of total billed charges for outpatient setting,2156.7,75,,1725.36,percent of total billed charges,75% of total billed charges for outpatient setting,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,2156.7,75,,1725.36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1006.46,35,,805.168,percent of total billed charges,35% of total billed charges for outpatient setting,2242.97,78,,1794.376,percent of total billed charges,78% of total billed charges for outpatient setting,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,2012.92,70,,1610.336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2156.7,75,,1725.36,percent of total billed charges,75% of total billed charges for outpatient setting,2386.75,83,,1909.4,percent of total billed charges,83% of total billed charges for outpatient setting,1437.8,50,,1150.24,percent of total billed charges,50% of total billed charges for outpatient setting,1437.8,50,,1150.24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1126.31,39.17,,901.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1006.46,2386.75,
COLONOSCOPY & POLYP,750271,CDM,360,RC,,,outpatient,,,3116.4,1558.2,,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1196.7,38.4,,957.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1196.7,38.4,,957.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,2337.3,75,,1869.84,percent of total billed charges,75% of total billed charges for outpatient setting,2337.3,75,,1869.84,percent of total billed charges,75% of total billed charges for outpatient setting,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,2337.3,75,,1869.84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1090.74,35,,872.592,percent of total billed charges,35% of total billed charges for outpatient setting,2430.79,78,,1944.632,percent of total billed charges,78% of total billed charges for outpatient setting,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,2181.48,70,,1745.184,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2337.3,75,,1869.84,percent of total billed charges,75% of total billed charges for outpatient setting,2586.61,83,,2069.288,percent of total billed charges,83% of total billed charges for outpatient setting,1558.2,50,,1246.56,percent of total billed charges,50% of total billed charges for outpatient setting,1558.2,50,,1246.56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1220.63,39.17,,976.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1090.74,2586.61,
COLONOSCOPY/MU POLY,750272,CDM,360,RC,,,outpatient,,,3236.8,1618.4,,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1242.93,38.4,,994.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1242.93,38.4,,994.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,2427.6,75,,1942.08,percent of total billed charges,75% of total billed charges for outpatient setting,2427.6,75,,1942.08,percent of total billed charges,75% of total billed charges for outpatient setting,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,2427.6,75,,1942.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1132.88,35,,906.304,percent of total billed charges,35% of total billed charges for outpatient setting,2524.7,78,,2019.76,percent of total billed charges,78% of total billed charges for outpatient setting,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,2265.76,70,,1812.608,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2427.6,75,,1942.08,percent of total billed charges,75% of total billed charges for outpatient setting,2686.54,83,,2149.232,percent of total billed charges,83% of total billed charges for outpatient setting,1618.4,50,,1294.72,percent of total billed charges,50% of total billed charges for outpatient setting,1618.4,50,,1294.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1267.79,39.17,,1014.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1132.88,2686.54,
PENROSE DRAINS 18,750506,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
LAP. CHOLECYSTECTOMY,755555,CDM,360,RC,,,outpatient,,,8654,4327,,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3323.14,38.4,,2658.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3323.14,38.4,,2658.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,6490.5,75,,5192.4,percent of total billed charges,75% of total billed charges for outpatient setting,6490.5,75,,5192.4,percent of total billed charges,75% of total billed charges for outpatient setting,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,6490.5,75,,5192.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3028.9,35,,2423.12,percent of total billed charges,35% of total billed charges for outpatient setting,6750.12,78,,5400.096,percent of total billed charges,78% of total billed charges for outpatient setting,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,6057.8,70,,4846.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6490.5,75,,5192.4,percent of total billed charges,75% of total billed charges for outpatient setting,7182.82,83,,5746.256,percent of total billed charges,83% of total billed charges for outpatient setting,4327,50,,3461.6,percent of total billed charges,50% of total billed charges for outpatient setting,4327,50,,3461.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3389.6,39.17,,2711.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3028.9,7182.82,
COLONOSCOPY HIGH RISK,755667,CDM,360,RC,,,outpatient,,,2608.2,1304.1,,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1001.55,38.4,,801.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1001.55,38.4,,801.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,1956.15,75,,1564.92,percent of total billed charges,75% of total billed charges for outpatient setting,1956.15,75,,1564.92,percent of total billed charges,75% of total billed charges for outpatient setting,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,1956.15,75,,1564.92,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,912.87,35,,730.296,percent of total billed charges,35% of total billed charges for outpatient setting,2034.4,78,,1627.52,percent of total billed charges,78% of total billed charges for outpatient setting,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,1825.74,70,,1460.592,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1956.15,75,,1564.92,percent of total billed charges,75% of total billed charges for outpatient setting,2164.81,83,,1731.848,percent of total billed charges,83% of total billed charges for outpatient setting,1304.1,50,,1043.28,percent of total billed charges,50% of total billed charges for outpatient setting,1304.1,50,,1043.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1021.58,39.17,,817.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,912.87,2164.81,
COLONOSCOPY SCREENING,755668,CDM,360,RC,,,outpatient,,,2282,1141,,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,876.29,38.4,,701.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,876.29,38.4,,701.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,798.7,35,,638.96,percent of total billed charges,35% of total billed charges for outpatient setting,1779.96,78,,1423.968,percent of total billed charges,78% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1894.06,83,,1515.248,percent of total billed charges,83% of total billed charges for outpatient setting,1141,50,,912.8,percent of total billed charges,50% of total billed charges for outpatient setting,1141,50,,912.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.82,39.17,,715.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,798.7,1894.06,
ENDO EXTENDED TIME,770070,CDM,270,RC,,,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.7,51.46,
15G CORE BX SYSTEM,772245,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
18G CORE BX SYSTEM,772246,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
A-P RESECTION,772258,CDM,360,RC,,,outpatient,,,3965,1982.5,,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1522.56,38.4,,1218.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1522.56,38.4,,1218.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,2973.75,75,,2379,percent of total billed charges,75% of total billed charges for outpatient setting,2973.75,75,,2379,percent of total billed charges,75% of total billed charges for outpatient setting,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,2973.75,75,,2379,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1387.75,35,,1110.2,percent of total billed charges,35% of total billed charges for outpatient setting,3092.7,78,,2474.16,percent of total billed charges,78% of total billed charges for outpatient setting,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,2775.5,70,,2220.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2973.75,75,,2379,percent of total billed charges,75% of total billed charges for outpatient setting,3290.95,83,,2632.76,percent of total billed charges,83% of total billed charges for outpatient setting,1982.5,50,,1586,percent of total billed charges,50% of total billed charges for outpatient setting,1982.5,50,,1586,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1553.01,39.17,,1242.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1387.75,3290.95,
ADENOIDECTOMY,772259,CDM,360,RC,,,outpatient,,,1235,617.5,,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,474.24,38.4,,379.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,474.24,38.4,,379.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,432.25,35,,345.8,percent of total billed charges,35% of total billed charges for outpatient setting,963.3,78,,770.64,percent of total billed charges,78% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,1025.05,83,,820.04,percent of total billed charges,83% of total billed charges for outpatient setting,617.5,50,,494,percent of total billed charges,50% of total billed charges for outpatient setting,617.5,50,,494,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.72,39.17,,386.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,432.25,1025.05,
AMPUTATION,772260,CDM,360,RC,,,outpatient,,,1067,533.5,,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,409.73,38.4,,327.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.73,38.4,,327.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,373.45,35,,298.76,percent of total billed charges,35% of total billed charges for outpatient setting,832.26,78,,665.808,percent of total billed charges,78% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,885.61,83,,708.488,percent of total billed charges,83% of total billed charges for outpatient setting,533.5,50,,426.8,percent of total billed charges,50% of total billed charges for outpatient setting,533.5,50,,426.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417.92,39.17,,334.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,373.45,885.61,
APPENDECTOMY,772261,CDM,360,RC,,,outpatient,,,1386,693,,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,532.22,38.4,,425.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,532.22,38.4,,425.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,1039.5,75,,831.6,percent of total billed charges,75% of total billed charges for outpatient setting,1039.5,75,,831.6,percent of total billed charges,75% of total billed charges for outpatient setting,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,1039.5,75,,831.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.1,35,,388.08,percent of total billed charges,35% of total billed charges for outpatient setting,1081.08,78,,864.864,percent of total billed charges,78% of total billed charges for outpatient setting,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,970.2,70,,776.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1039.5,75,,831.6,percent of total billed charges,75% of total billed charges for outpatient setting,1150.38,83,,920.304,percent of total billed charges,83% of total billed charges for outpatient setting,693,50,,554.4,percent of total billed charges,50% of total billed charges for outpatient setting,693,50,,554.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,542.86,39.17,,434.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,485.1,1150.38,
BX SOFT TISSUE,772262,CDM,360,RC,,,outpatient,,,2147.6,1073.8,,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,824.68,38.4,,659.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,824.68,38.4,,659.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,75,,1288.56,percent of total billed charges,75% of total billed charges for outpatient setting,1610.7,75,,1288.56,percent of total billed charges,75% of total billed charges for outpatient setting,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,75,,1288.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,751.66,35,,601.328,percent of total billed charges,35% of total billed charges for outpatient setting,1675.13,78,,1340.104,percent of total billed charges,78% of total billed charges for outpatient setting,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,1503.32,70,,1202.656,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1610.7,75,,1288.56,percent of total billed charges,75% of total billed charges for outpatient setting,1782.51,83,,1426.008,percent of total billed charges,83% of total billed charges for outpatient setting,1073.8,50,,859.04,percent of total billed charges,50% of total billed charges for outpatient setting,1073.8,50,,859.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,841.17,39.17,,672.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,751.66,1782.51,
BUNIONECTOMY,772263,CDM,360,RC,,,outpatient,,,1067,533.5,,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,409.73,38.4,,327.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.73,38.4,,327.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,373.45,35,,298.76,percent of total billed charges,35% of total billed charges for outpatient setting,832.26,78,,665.808,percent of total billed charges,78% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,746.9,70,,597.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.25,75,,640.2,percent of total billed charges,75% of total billed charges for outpatient setting,885.61,83,,708.488,percent of total billed charges,83% of total billed charges for outpatient setting,533.5,50,,426.8,percent of total billed charges,50% of total billed charges for outpatient setting,533.5,50,,426.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417.92,39.17,,334.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,373.45,885.61,
BREAST BX,772264,CDM,360,RC,,,outpatient,,,690,345,,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,241.5,35,,193.2,percent of total billed charges,35% of total billed charges for outpatient setting,538.2,78,,430.56,percent of total billed charges,78% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,572.7,83,,458.16,percent of total billed charges,83% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.26,39.17,,216.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,241.5,572.7,
CARPEL TUNNEL RELEAS,772265,CDM,360,RC,,,outpatient,,,1143,571.5,,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438.91,38.4,,351.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.91,38.4,,351.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400.05,35,,320.04,percent of total billed charges,35% of total billed charges for outpatient setting,891.54,78,,713.232,percent of total billed charges,78% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,948.69,83,,758.952,percent of total billed charges,83% of total billed charges for outpatient setting,571.5,50,,457.2,percent of total billed charges,50% of total billed charges for outpatient setting,571.5,50,,457.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447.69,39.17,,358.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,400.05,948.69,
CHOLECYSTECTOMY,772266,CDM,360,RC,,,outpatient,,,2302,1151,,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,883.97,38.4,,707.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,883.97,38.4,,707.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,1726.5,75,,1381.2,percent of total billed charges,75% of total billed charges for outpatient setting,1726.5,75,,1381.2,percent of total billed charges,75% of total billed charges for outpatient setting,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,1726.5,75,,1381.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,805.7,35,,644.56,percent of total billed charges,35% of total billed charges for outpatient setting,1795.56,78,,1436.448,percent of total billed charges,78% of total billed charges for outpatient setting,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,1611.4,70,,1289.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1726.5,75,,1381.2,percent of total billed charges,75% of total billed charges for outpatient setting,1910.66,83,,1528.528,percent of total billed charges,83% of total billed charges for outpatient setting,1151,50,,920.8,percent of total billed charges,50% of total billed charges for outpatient setting,1151,50,,920.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,901.65,39.17,,721.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,805.7,1910.66,
CIRCUMCISION,772267,CDM,723,RC,,,outpatient,,,1392,696,,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,534.53,38.4,,427.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,534.53,38.4,,427.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,1044,75,,835.2,percent of total billed charges,75% of total billed charges for outpatient setting,1044,75,,835.2,percent of total billed charges,75% of total billed charges for outpatient setting,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,1044,75,,835.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,487.2,35,,389.76,percent of total billed charges,35% of total billed charges for outpatient setting,1085.76,78,,868.608,percent of total billed charges,78% of total billed charges for outpatient setting,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,974.4,70,,779.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1044,75,,835.2,percent of total billed charges,75% of total billed charges for outpatient setting,1155.36,83,,924.288,percent of total billed charges,83% of total billed charges for outpatient setting,696,50,,556.8,percent of total billed charges,50% of total billed charges for outpatient setting,696,50,,556.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,545.22,39.17,,436.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,487.2,1155.36,
COLECTOMY/COLON SURG,772268,CDM,360,RC,,,outpatient,,,3151,1575.5,,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1102.85,35,,882.28,percent of total billed charges,35% of total billed charges for outpatient setting,2457.78,78,,1966.224,percent of total billed charges,78% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2615.33,83,,2092.264,percent of total billed charges,83% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1234.18,39.17,,987.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1102.85,2615.33,
DEBRIDEMENT,772269,CDM,360,RC,,,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,448.7,1064.06,
D & C,772270,CDM,360,RC,,,outpatient,,,1204,602,,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,462.34,38.4,,369.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,462.34,38.4,,369.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,903,75,,722.4,percent of total billed charges,75% of total billed charges for outpatient setting,903,75,,722.4,percent of total billed charges,75% of total billed charges for outpatient setting,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,903,75,,722.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,421.4,35,,337.12,percent of total billed charges,35% of total billed charges for outpatient setting,939.12,78,,751.296,percent of total billed charges,78% of total billed charges for outpatient setting,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,842.8,70,,674.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,903,75,,722.4,percent of total billed charges,75% of total billed charges for outpatient setting,999.32,83,,799.456,percent of total billed charges,83% of total billed charges for outpatient setting,602,50,,481.6,percent of total billed charges,50% of total billed charges for outpatient setting,602,50,,481.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,471.59,39.17,,377.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,421.4,999.32,
EX GANGLION CYST,772271,CDM,360,RC,,,outpatient,,,1957,978.5,,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,751.49,38.4,,601.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,751.49,38.4,,601.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,1467.75,75,,1174.2,percent of total billed charges,75% of total billed charges for outpatient setting,1467.75,75,,1174.2,percent of total billed charges,75% of total billed charges for outpatient setting,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,1467.75,75,,1174.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,684.95,35,,547.96,percent of total billed charges,35% of total billed charges for outpatient setting,1526.46,78,,1221.168,percent of total billed charges,78% of total billed charges for outpatient setting,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,1369.9,70,,1095.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1467.75,75,,1174.2,percent of total billed charges,75% of total billed charges for outpatient setting,1624.31,83,,1299.448,percent of total billed charges,83% of total billed charges for outpatient setting,978.5,50,,782.8,percent of total billed charges,50% of total billed charges for outpatient setting,978.5,50,,782.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,766.52,39.17,,613.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,684.95,1624.31,
EX LAPAROTOMY,772272,CDM,360,RC,,,outpatient,,,2727,1363.5,,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1047.17,38.4,,837.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1047.17,38.4,,837.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,2045.25,75,,1636.2,percent of total billed charges,75% of total billed charges for outpatient setting,2045.25,75,,1636.2,percent of total billed charges,75% of total billed charges for outpatient setting,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,2045.25,75,,1636.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,954.45,35,,763.56,percent of total billed charges,35% of total billed charges for outpatient setting,2127.06,78,,1701.648,percent of total billed charges,78% of total billed charges for outpatient setting,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,1908.9,70,,1527.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2045.25,75,,1636.2,percent of total billed charges,75% of total billed charges for outpatient setting,2263.41,83,,1810.728,percent of total billed charges,83% of total billed charges for outpatient setting,1363.5,50,,1090.8,percent of total billed charges,50% of total billed charges for outpatient setting,1363.5,50,,1090.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1068.11,39.17,,854.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,954.45,2263.41,
FISSURECTOMY/FISTULE,772273,CDM,360,RC,,,outpatient,,,1447,723.5,,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,555.65,38.4,,444.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,555.65,38.4,,444.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,1085.25,75,,868.2,percent of total billed charges,75% of total billed charges for outpatient setting,1085.25,75,,868.2,percent of total billed charges,75% of total billed charges for outpatient setting,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,1085.25,75,,868.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,506.45,35,,405.16,percent of total billed charges,35% of total billed charges for outpatient setting,1128.66,78,,902.928,percent of total billed charges,78% of total billed charges for outpatient setting,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,1012.9,70,,810.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1085.25,75,,868.2,percent of total billed charges,75% of total billed charges for outpatient setting,1201.01,83,,960.808,percent of total billed charges,83% of total billed charges for outpatient setting,723.5,50,,578.8,percent of total billed charges,50% of total billed charges for outpatient setting,723.5,50,,578.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,566.76,39.17,,453.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,506.45,1201.01,
FULL THICKNESS GRAFT,772274,CDM,360,RC,,,outpatient,,,1604,802,,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,561.4,35,,449.12,percent of total billed charges,35% of total billed charges for outpatient setting,1251.12,78,,1000.896,percent of total billed charges,78% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1331.32,83,,1065.056,percent of total billed charges,83% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,628.26,39.17,,502.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,561.4,1331.32,
HEMORRHOIDECTOMY,772275,CDM,360,RC,,,outpatient,,,1264,632,,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.4,35,,353.92,percent of total billed charges,35% of total billed charges for outpatient setting,985.92,78,,788.736,percent of total billed charges,78% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,1049.12,83,,839.296,percent of total billed charges,83% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495.09,39.17,,396.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,442.4,1049.12,
HERNIORRHAPY/ING/UMB,772276,CDM,360,RC,,,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,570.5,50,,456.4,percent of total billed charges,50% of total billed charges for outpatient setting,570.5,50,,456.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,399.35,947.03,
HYDROCELECTOMY,772277,CDM,360,RC,,,outpatient,,,1480,740,,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,568.32,38.4,,454.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,568.32,38.4,,454.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,518,35,,414.4,percent of total billed charges,35% of total billed charges for outpatient setting,1154.4,78,,923.52,percent of total billed charges,78% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1228.4,83,,982.72,percent of total billed charges,83% of total billed charges for outpatient setting,740,50,,592,percent of total billed charges,50% of total billed charges for outpatient setting,740,50,,592,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,579.69,39.17,,463.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,518,1228.4,
TOTAL ABDOMINAL HYST,772279,CDM,360,RC,,,outpatient,,,2798,1399,,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1074.43,38.4,,859.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1074.43,38.4,,859.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,2098.5,75,,1678.8,percent of total billed charges,75% of total billed charges for outpatient setting,2098.5,75,,1678.8,percent of total billed charges,75% of total billed charges for outpatient setting,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,2098.5,75,,1678.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,979.3,35,,783.44,percent of total billed charges,35% of total billed charges for outpatient setting,2182.44,78,,1745.952,percent of total billed charges,78% of total billed charges for outpatient setting,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,1958.6,70,,1566.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2098.5,75,,1678.8,percent of total billed charges,75% of total billed charges for outpatient setting,2322.34,83,,1857.872,percent of total billed charges,83% of total billed charges for outpatient setting,1399,50,,1119.2,percent of total billed charges,50% of total billed charges for outpatient setting,1399,50,,1119.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1095.92,39.17,,876.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,979.3,2322.34,
I & D,772280,CDM,360,RC,,,outpatient,,,1405,702.5,,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.75,35,,393.4,percent of total billed charges,35% of total billed charges for outpatient setting,1095.9,78,,876.72,percent of total billed charges,78% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1166.15,83,,932.92,percent of total billed charges,83% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,550.31,39.17,,440.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,491.75,1166.15,
MASTECTOMY,772281,CDM,360,RC,,,outpatient,,,2333,1166.5,,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.55,35,,653.24,percent of total billed charges,35% of total billed charges for outpatient setting,1819.74,78,,1455.792,percent of total billed charges,78% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1936.39,83,,1549.112,percent of total billed charges,83% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.79,39.17,,731.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.55,1936.39,
THYROIDECTOMY,772282,CDM,360,RC,,,outpatient,,,1710,855,,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.64,38.4,,525.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,656.64,38.4,,525.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,1282.5,75,,1026,percent of total billed charges,75% of total billed charges for outpatient setting,1282.5,75,,1026,percent of total billed charges,75% of total billed charges for outpatient setting,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,1282.5,75,,1026,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,598.5,35,,478.8,percent of total billed charges,35% of total billed charges for outpatient setting,1333.8,78,,1067.04,percent of total billed charges,78% of total billed charges for outpatient setting,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,1197,70,,957.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1282.5,75,,1026,percent of total billed charges,75% of total billed charges for outpatient setting,1419.3,83,,1135.44,percent of total billed charges,83% of total billed charges for outpatient setting,855,50,,684,percent of total billed charges,50% of total billed charges for outpatient setting,855,50,,684,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,669.77,39.17,,535.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,598.5,1419.3,
SUMP TUBE N/G,772292,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
SUTURE SINGLE PACK,772293,CDM,272,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
SUTURE MULT PACK,772294,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
SUTURE TIE,772296,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
PAIN MGT TRIGGER POI,772301,CDM,360,RC,,,outpatient,,,630,315,,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,241.92,38.4,,193.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.92,38.4,,193.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,472.5,75,,378,percent of total billed charges,75% of total billed charges for outpatient setting,472.5,75,,378,percent of total billed charges,75% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,472.5,75,,378,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.5,35,,176.4,percent of total billed charges,35% of total billed charges for outpatient setting,491.4,78,,393.12,percent of total billed charges,78% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,472.5,75,,378,percent of total billed charges,75% of total billed charges for outpatient setting,522.9,83,,418.32,percent of total billed charges,83% of total billed charges for outpatient setting,315,50,,252,percent of total billed charges,50% of total billed charges for outpatient setting,315,50,,252,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.76,39.17,,197.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,220.5,522.9,
PAIN MGT EPIDURAL,772302,CDM,370,RC,1967,HCPCS,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
PEG TUBE PROCEDURE,772303,CDM,360,RC,,,outpatient,,,842,421,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,294.7,35,,235.76,percent of total billed charges,35% of total billed charges for outpatient setting,656.76,78,,525.408,percent of total billed charges,78% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,698.86,83,,559.088,percent of total billed charges,83% of total billed charges for outpatient setting,421,50,,336.8,percent of total billed charges,50% of total billed charges for outpatient setting,421,50,,336.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,329.8,39.17,,263.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,294.7,698.86,
LAP HERNIA,772304,CDM,360,RC,,,outpatient,,,13251,6625.5,,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5088.38,38.4,,4070.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5088.38,38.4,,4070.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,9938.25,75,,7950.6,percent of total billed charges,75% of total billed charges for outpatient setting,9938.25,75,,7950.6,percent of total billed charges,75% of total billed charges for outpatient setting,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,9938.25,75,,7950.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4637.85,35,,3710.28,percent of total billed charges,35% of total billed charges for outpatient setting,10335.78,78,,8268.624,percent of total billed charges,78% of total billed charges for outpatient setting,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,9275.7,70,,7420.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9938.25,75,,7950.6,percent of total billed charges,75% of total billed charges for outpatient setting,10998.33,83,,8798.664,percent of total billed charges,83% of total billed charges for outpatient setting,6625.5,50,,5300.4,percent of total billed charges,50% of total billed charges for outpatient setting,6625.5,50,,5300.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5190.15,39.17,,4152.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4637.85,10998.33,
LAP TUBAL,772305,CDM,360,RC,,,outpatient,,,5490,2745,,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2108.16,38.4,,1686.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2108.16,38.4,,1686.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1921.5,35,,1537.2,percent of total billed charges,35% of total billed charges for outpatient setting,4282.2,78,,3425.76,percent of total billed charges,78% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,4556.7,83,,3645.36,percent of total billed charges,83% of total billed charges for outpatient setting,2745,50,,2196,percent of total billed charges,50% of total billed charges for outpatient setting,2745,50,,2196,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2150.32,39.17,,1720.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1921.5,4556.7,
CAST PL KN-FT ADULT,772306,CDM,270,RC,,,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.1,54.78,
CAST PL TH-FT ADULT,772307,CDM,270,RC,,,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.85,92.13,
CAST PL ANKLE ADULT,772309,CDM,270,RC,,,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.45,72.21,
CAST PL KN-FT CHILD,772310,CDM,270,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
CAST PL LG-ARM ADULT,772311,CDM,270,RC,,,outpatient,,,69,34.5,,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.15,35,,19.32,percent of total billed charges,35% of total billed charges for outpatient setting,53.82,78,,43.056,percent of total billed charges,78% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,57.27,83,,45.816,percent of total billed charges,83% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.03,39.17,,21.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.15,57.27,
CAST PL SHORT ARM AD,772312,CDM,270,RC,,,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.3,48.14,
CAST PL TH-FT CHILD,772313,CDM,270,RC,,,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
CAST SYN ANKLE ADULT,772315,CDM,270,RC,,,outpatient,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.65,35,,27.72,percent of total billed charges,35% of total billed charges for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.78,39.17,,31.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.65,82.17,
CAST SYN KN-FT ADULT,772316,CDM,270,RC,,,outpatient,,,175,87.5,,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.25,35,,49,percent of total billed charges,35% of total billed charges for outpatient setting,136.5,78,,109.2,percent of total billed charges,78% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,145.25,83,,116.2,percent of total billed charges,83% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.54,39.17,,54.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,61.25,145.25,
CAST SYN KN-FT CHILD,772317,CDM,270,RC,,,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.4,35,,29.12,percent of total billed charges,35% of total billed charges for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.74,39.17,,32.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.4,86.32,
CAST SYN LG ARM ADUL,772318,CDM,270,RC,,,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.55,35,,37.24,percent of total billed charges,35% of total billed charges for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.09,39.17,,41.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.55,110.39,
CAST SYN SH ARM ADUL,772319,CDM,270,RC,,,outpatient,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.65,35,,27.72,percent of total billed charges,35% of total billed charges for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.78,39.17,,31.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.65,82.17,
CAST SYN TH-FT ADULT,772321,CDM,270,RC,,,outpatient,,,239,119.5,,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.78,38.4,,73.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.78,38.4,,73.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.65,35,,66.92,percent of total billed charges,35% of total billed charges for outpatient setting,186.42,78,,149.136,percent of total billed charges,78% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,198.37,83,,158.696,percent of total billed charges,83% of total billed charges for outpatient setting,119.5,50,,95.6,percent of total billed charges,50% of total billed charges for outpatient setting,119.5,50,,95.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.62,39.17,,74.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,83.65,198.37,
CAST SYN TH-FT CHILD,772322,CDM,270,RC,,,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,35,,37.8,percent of total billed charges,35% of total billed charges for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.88,39.17,,42.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.25,112.05,
MANIPULATION,772323,CDM,360,RC,,,outpatient,,,1905,952.5,,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.52,38.4,,585.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,731.52,38.4,,585.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,666.75,35,,533.4,percent of total billed charges,35% of total billed charges for outpatient setting,1485.9,78,,1188.72,percent of total billed charges,78% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1581.15,83,,1264.92,percent of total billed charges,83% of total billed charges for outpatient setting,952.5,50,,762,percent of total billed charges,50% of total billed charges for outpatient setting,952.5,50,,762,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.15,39.17,,596.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,666.75,1581.15,
VEIN STRIPPING,775004,CDM,360,RC,,,outpatient,,,1905,952.5,,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.52,38.4,,585.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,731.52,38.4,,585.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,666.75,35,,533.4,percent of total billed charges,35% of total billed charges for outpatient setting,1485.9,78,,1188.72,percent of total billed charges,78% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,1333.5,70,,1066.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1428.75,75,,1143,percent of total billed charges,75% of total billed charges for outpatient setting,1581.15,83,,1264.92,percent of total billed charges,83% of total billed charges for outpatient setting,952.5,50,,762,percent of total billed charges,50% of total billed charges for outpatient setting,952.5,50,,762,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.15,39.17,,596.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,666.75,1581.15,
ENDO CURVED DISSECT,775008,CDM,270,RC,,,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.8,172.64,
PORTA A CATH INSERT,775016,CDM,360,RC,,,outpatient,,,1640,820,,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,629.76,38.4,,503.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,629.76,38.4,,503.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,1230,75,,984,percent of total billed charges,75% of total billed charges for outpatient setting,1230,75,,984,percent of total billed charges,75% of total billed charges for outpatient setting,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,1230,75,,984,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,574,35,,459.2,percent of total billed charges,35% of total billed charges for outpatient setting,1279.2,78,,1023.36,percent of total billed charges,78% of total billed charges for outpatient setting,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,1148,70,,918.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1230,75,,984,percent of total billed charges,75% of total billed charges for outpatient setting,1361.2,83,,1088.96,percent of total billed charges,83% of total billed charges for outpatient setting,820,50,,656,percent of total billed charges,50% of total billed charges for outpatient setting,820,50,,656,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,642.36,39.17,,513.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,574,1361.2,
TENDON REPAIR,775018,CDM,360,RC,,,outpatient,,,2393,1196.5,,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.91,38.4,,735.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,918.91,38.4,,735.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,1794.75,75,,1435.8,percent of total billed charges,75% of total billed charges for outpatient setting,1794.75,75,,1435.8,percent of total billed charges,75% of total billed charges for outpatient setting,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,1794.75,75,,1435.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,837.55,35,,670.04,percent of total billed charges,35% of total billed charges for outpatient setting,1866.54,78,,1493.232,percent of total billed charges,78% of total billed charges for outpatient setting,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,1675.1,70,,1340.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1794.75,75,,1435.8,percent of total billed charges,75% of total billed charges for outpatient setting,1986.19,83,,1588.952,percent of total billed charges,83% of total billed charges for outpatient setting,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges for outpatient setting,1196.5,50,,957.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,937.29,39.17,,749.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,837.55,1986.19,
CYSTOSCOPE,775020,CDM,360,RC,,,outpatient,,,1601,800.5,,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,614.78,38.4,,491.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,614.78,38.4,,491.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,1200.75,75,,960.6,percent of total billed charges,75% of total billed charges for outpatient setting,1200.75,75,,960.6,percent of total billed charges,75% of total billed charges for outpatient setting,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,1200.75,75,,960.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,560.35,35,,448.28,percent of total billed charges,35% of total billed charges for outpatient setting,1248.78,78,,999.024,percent of total billed charges,78% of total billed charges for outpatient setting,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,1120.7,70,,896.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1200.75,75,,960.6,percent of total billed charges,75% of total billed charges for outpatient setting,1328.83,83,,1063.064,percent of total billed charges,83% of total billed charges for outpatient setting,800.5,50,,640.4,percent of total billed charges,50% of total billed charges for outpatient setting,800.5,50,,640.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.08,39.17,,501.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,560.35,1328.83,
VAG HYSTERECTOMY,775023,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
RELEASE DUPUYTREN,775024,CDM,360,RC,,,outpatient,,,1528,764,,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.75,38.4,,469.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,586.75,38.4,,469.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,1146,75,,916.8,percent of total billed charges,75% of total billed charges for outpatient setting,1146,75,,916.8,percent of total billed charges,75% of total billed charges for outpatient setting,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,1146,75,,916.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,534.8,35,,427.84,percent of total billed charges,35% of total billed charges for outpatient setting,1191.84,78,,953.472,percent of total billed charges,78% of total billed charges for outpatient setting,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,1069.6,70,,855.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1146,75,,916.8,percent of total billed charges,75% of total billed charges for outpatient setting,1268.24,83,,1014.592,percent of total billed charges,83% of total billed charges for outpatient setting,764,50,,611.2,percent of total billed charges,50% of total billed charges for outpatient setting,764,50,,611.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,598.49,39.17,,478.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,534.8,1268.24,
EXP LAP SALP/OOPH,775026,CDM,360,RC,,,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,121.8,288.84,
SUCTION D N C,775032,CDM,360,RC,,,outpatient,,,1184,592,,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.66,38.4,,363.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,454.66,38.4,,363.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,414.4,35,,331.52,percent of total billed charges,35% of total billed charges for outpatient setting,923.52,78,,738.816,percent of total billed charges,78% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,982.72,83,,786.176,percent of total billed charges,83% of total billed charges for outpatient setting,592,50,,473.6,percent of total billed charges,50% of total billed charges for outpatient setting,592,50,,473.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,463.75,39.17,,371,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,414.4,982.72,
RETRO PUBIC URO PLEX,775033,CDM,360,RC,,,outpatient,,,1918,959,,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,736.51,38.4,,589.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,736.51,38.4,,589.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,1438.5,75,,1150.8,percent of total billed charges,75% of total billed charges for outpatient setting,1438.5,75,,1150.8,percent of total billed charges,75% of total billed charges for outpatient setting,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,1438.5,75,,1150.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,671.3,35,,537.04,percent of total billed charges,35% of total billed charges for outpatient setting,1496.04,78,,1196.832,percent of total billed charges,78% of total billed charges for outpatient setting,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,1342.6,70,,1074.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1438.5,75,,1150.8,percent of total billed charges,75% of total billed charges for outpatient setting,1591.94,83,,1273.552,percent of total billed charges,83% of total billed charges for outpatient setting,959,50,,767.2,percent of total billed charges,50% of total billed charges for outpatient setting,959,50,,767.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,751.24,39.17,,600.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,671.3,1591.94,
EXP STAB WOUND,775034,CDM,360,RC,,,outpatient,,,1986,993,,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.62,38.4,,610.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,762.62,38.4,,610.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,1489.5,75,,1191.6,percent of total billed charges,75% of total billed charges for outpatient setting,1489.5,75,,1191.6,percent of total billed charges,75% of total billed charges for outpatient setting,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,1489.5,75,,1191.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,695.1,35,,556.08,percent of total billed charges,35% of total billed charges for outpatient setting,1549.08,78,,1239.264,percent of total billed charges,78% of total billed charges for outpatient setting,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,1390.2,70,,1112.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1489.5,75,,1191.6,percent of total billed charges,75% of total billed charges for outpatient setting,1648.38,83,,1318.704,percent of total billed charges,83% of total billed charges for outpatient setting,993,50,,794.4,percent of total billed charges,50% of total billed charges for outpatient setting,993,50,,794.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,777.87,39.17,,622.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,695.1,1648.38,
PAIN MGT CLINIC VISI,775035,CDM,510,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
ROOM CHARGE/PAIN MGT,775036,CDM,761,RC,,,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
UNI PUNCH BIOPSY,775038,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
COLD KNIFE CONE,775043,CDM,360,RC,,,outpatient,,,1066,533,,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,409.34,38.4,,327.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.34,38.4,,327.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,799.5,75,,639.6,percent of total billed charges,75% of total billed charges for outpatient setting,799.5,75,,639.6,percent of total billed charges,75% of total billed charges for outpatient setting,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,799.5,75,,639.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,373.1,35,,298.48,percent of total billed charges,35% of total billed charges for outpatient setting,831.48,78,,665.184,percent of total billed charges,78% of total billed charges for outpatient setting,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,746.2,70,,596.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,799.5,75,,639.6,percent of total billed charges,75% of total billed charges for outpatient setting,884.78,83,,707.824,percent of total billed charges,83% of total billed charges for outpatient setting,533,50,,426.4,percent of total billed charges,50% of total billed charges for outpatient setting,533,50,,426.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417.53,39.17,,334.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,373.1,884.78,
LAVH,775050,CDM,360,RC,,,outpatient,,,5754,2877,,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2209.54,38.4,,1767.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2209.54,38.4,,1767.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2013.9,35,,1611.12,percent of total billed charges,35% of total billed charges for outpatient setting,4488.12,78,,3590.496,percent of total billed charges,78% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4775.82,83,,3820.656,percent of total billed charges,83% of total billed charges for outpatient setting,2877,50,,2301.6,percent of total billed charges,50% of total billed charges for outpatient setting,2877,50,,2301.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2253.73,39.17,,1802.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2013.9,4775.82,
SURGICAL BLADE #10,775057,CDM,270,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
CERCLAGE,775074,CDM,360,RC,,,outpatient,,,1736,868,,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,666.62,38.4,,533.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,666.62,38.4,,533.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1302,75,,1041.6,percent of total billed charges,75% of total billed charges for outpatient setting,1302,75,,1041.6,percent of total billed charges,75% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1302,75,,1041.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,607.6,35,,486.08,percent of total billed charges,35% of total billed charges for outpatient setting,1354.08,78,,1083.264,percent of total billed charges,78% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1302,75,,1041.6,percent of total billed charges,75% of total billed charges for outpatient setting,1440.88,83,,1152.704,percent of total billed charges,83% of total billed charges for outpatient setting,868,50,,694.4,percent of total billed charges,50% of total billed charges for outpatient setting,868,50,,694.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,679.95,39.17,,543.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,607.6,1440.88,
FEM POP BYPASS,775075,CDM,360,RC,,,outpatient,,,2296,1148,,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,803.6,35,,642.88,percent of total billed charges,35% of total billed charges for outpatient setting,1790.88,78,,1432.704,percent of total billed charges,78% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1905.68,83,,1524.544,percent of total billed charges,83% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.29,39.17,,719.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,803.6,1905.68,
REMOVAL TOE NAIL,775076,CDM,360,RC,,,outpatient,,,1135,567.5,,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,435.84,38.4,,348.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,435.84,38.4,,348.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,397.25,35,,317.8,percent of total billed charges,35% of total billed charges for outpatient setting,885.3,78,,708.24,percent of total billed charges,78% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,942.05,83,,753.64,percent of total billed charges,83% of total billed charges for outpatient setting,567.5,50,,454,percent of total billed charges,50% of total billed charges for outpatient setting,567.5,50,,454,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,444.56,39.17,,355.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,397.25,942.05,
EXP LAPARASCOPY,775077,CDM,360,RC,,,outpatient,,,3994,1997,,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1397.9,35,,1118.32,percent of total billed charges,35% of total billed charges for outpatient setting,3115.32,78,,2492.256,percent of total billed charges,78% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,3315.02,83,,2652.016,percent of total billed charges,83% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1564.37,39.17,,1251.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1397.9,3315.02,
MINOR PROCEDURE,775079,CDM,360,RC,,,outpatient,,,1667,833.5,,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,640.13,38.4,,512.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,640.13,38.4,,512.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges for outpatient setting,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges for outpatient setting,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,583.45,35,,466.76,percent of total billed charges,35% of total billed charges for outpatient setting,1300.26,78,,1040.208,percent of total billed charges,78% of total billed charges for outpatient setting,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,1166.9,70,,933.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1250.25,75,,1000.2,percent of total billed charges,75% of total billed charges for outpatient setting,1383.61,83,,1106.888,percent of total billed charges,83% of total billed charges for outpatient setting,833.5,50,,666.8,percent of total billed charges,50% of total billed charges for outpatient setting,833.5,50,,666.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,652.93,39.17,,522.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,583.45,1383.61,
SURGICAL BLADES #11,775080,CDM,270,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
SURGICAL BLADES #15,775081,CDM,270,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
C SECTION,777802,CDM,360,RC,,,outpatient,,,2333,1166.5,,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.55,35,,653.24,percent of total billed charges,35% of total billed charges for outpatient setting,1819.74,78,,1455.792,percent of total billed charges,78% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1936.39,83,,1549.112,percent of total billed charges,83% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.79,39.17,,731.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.55,1936.39,
GYN A & P REPAIR,777810,CDM,360,RC,,,outpatient,,,2266,1133,,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,870.14,38.4,,696.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,870.14,38.4,,696.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,1699.5,75,,1359.6,percent of total billed charges,75% of total billed charges for outpatient setting,1699.5,75,,1359.6,percent of total billed charges,75% of total billed charges for outpatient setting,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,1699.5,75,,1359.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,793.1,35,,634.48,percent of total billed charges,35% of total billed charges for outpatient setting,1767.48,78,,1413.984,percent of total billed charges,78% of total billed charges for outpatient setting,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,1586.2,70,,1268.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1699.5,75,,1359.6,percent of total billed charges,75% of total billed charges for outpatient setting,1880.78,83,,1504.624,percent of total billed charges,83% of total billed charges for outpatient setting,1133,50,,906.4,percent of total billed charges,50% of total billed charges for outpatient setting,1133,50,,906.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,887.54,39.17,,710.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,793.1,1880.78,
ARTHROSCOPY,777823,CDM,360,RC,,,outpatient,,,5013,2506.5,,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1924.99,38.4,,1539.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1924.99,38.4,,1539.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,3759.75,75,,3007.8,percent of total billed charges,75% of total billed charges for outpatient setting,3759.75,75,,3007.8,percent of total billed charges,75% of total billed charges for outpatient setting,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,3759.75,75,,3007.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1754.55,35,,1403.64,percent of total billed charges,35% of total billed charges for outpatient setting,3910.14,78,,3128.112,percent of total billed charges,78% of total billed charges for outpatient setting,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,3509.1,70,,2807.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3759.75,75,,3007.8,percent of total billed charges,75% of total billed charges for outpatient setting,4160.79,83,,3328.632,percent of total billed charges,83% of total billed charges for outpatient setting,2506.5,50,,2005.2,percent of total billed charges,50% of total billed charges for outpatient setting,2506.5,50,,2005.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1963.49,39.17,,1570.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1754.55,4160.79,
REPAIR URETHRAL DIV,777825,CDM,360,RC,,,outpatient,,,2079,1039.5,,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,798.34,38.4,,638.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,798.34,38.4,,638.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges for outpatient setting,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges for outpatient setting,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,727.65,35,,582.12,percent of total billed charges,35% of total billed charges for outpatient setting,1621.62,78,,1297.296,percent of total billed charges,78% of total billed charges for outpatient setting,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,1455.3,70,,1164.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1559.25,75,,1247.4,percent of total billed charges,75% of total billed charges for outpatient setting,1725.57,83,,1380.456,percent of total billed charges,83% of total billed charges for outpatient setting,1039.5,50,,831.6,percent of total billed charges,50% of total billed charges for outpatient setting,1039.5,50,,831.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,814.31,39.17,,651.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,727.65,1725.57,
PAIN MGT SYMPATH BLK,777826,CDM,360,RC,,,outpatient,,,714,357,,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.18,38.4,,219.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,274.18,38.4,,219.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,535.5,75,,428.4,percent of total billed charges,75% of total billed charges for outpatient setting,535.5,75,,428.4,percent of total billed charges,75% of total billed charges for outpatient setting,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,535.5,75,,428.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,249.9,35,,199.92,percent of total billed charges,35% of total billed charges for outpatient setting,556.92,78,,445.536,percent of total billed charges,78% of total billed charges for outpatient setting,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,499.8,70,,399.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,535.5,75,,428.4,percent of total billed charges,75% of total billed charges for outpatient setting,592.62,83,,474.096,percent of total billed charges,83% of total billed charges for outpatient setting,357,50,,285.6,percent of total billed charges,50% of total billed charges for outpatient setting,357,50,,285.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279.66,39.17,,223.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,249.9,592.62,
PAIN MGT SYMPATH BLK,777827,CDM,360,RC,,,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,229.25,543.65,
TRACHEOSTOMY,777828,CDM,360,RC,,,outpatient,,,1675,837.5,,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.25,35,,469,percent of total billed charges,35% of total billed charges for outpatient setting,1306.5,78,,1045.2,percent of total billed charges,78% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1390.25,83,,1112.2,percent of total billed charges,83% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.06,39.17,,524.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,586.25,1390.25,
OPEN REDUCTION,777829,CDM,360,RC,,,outpatient,,,1430,715,,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,549.12,38.4,,439.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,549.12,38.4,,439.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,1072.5,75,,858,percent of total billed charges,75% of total billed charges for outpatient setting,1072.5,75,,858,percent of total billed charges,75% of total billed charges for outpatient setting,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,1072.5,75,,858,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,500.5,35,,400.4,percent of total billed charges,35% of total billed charges for outpatient setting,1115.4,78,,892.32,percent of total billed charges,78% of total billed charges for outpatient setting,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,1001,70,,800.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1072.5,75,,858,percent of total billed charges,75% of total billed charges for outpatient setting,1186.9,83,,949.52,percent of total billed charges,83% of total billed charges for outpatient setting,715,50,,572,percent of total billed charges,50% of total billed charges for outpatient setting,715,50,,572,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,560.1,39.17,,448.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,500.5,1186.9,
BIPOLAR HIP,777836,CDM,360,RC,,,outpatient,,,4404,2202,,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1691.14,38.4,,1352.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1691.14,38.4,,1352.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,3303,75,,2642.4,percent of total billed charges,75% of total billed charges for outpatient setting,3303,75,,2642.4,percent of total billed charges,75% of total billed charges for outpatient setting,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,3303,75,,2642.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1541.4,35,,1233.12,percent of total billed charges,35% of total billed charges for outpatient setting,3435.12,78,,2748.096,percent of total billed charges,78% of total billed charges for outpatient setting,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,3082.8,70,,2466.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3303,75,,2642.4,percent of total billed charges,75% of total billed charges for outpatient setting,3655.32,83,,2924.256,percent of total billed charges,83% of total billed charges for outpatient setting,2202,50,,1761.6,percent of total billed charges,50% of total billed charges for outpatient setting,2202,50,,1761.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1724.96,39.17,,1379.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1541.4,3655.32,
OP I/D MINOR CHARGE,777840,CDM,360,RC,,,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.2,35,,25.76,percent of total billed charges,35% of total billed charges for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.04,39.17,,28.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.2,76.36,
BLOOD PATCH,777842,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
CLOSED REDUCTION PIN,777851,CDM,360,RC,,,outpatient,,,4413,2206.5,,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1694.59,38.4,,1355.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1694.59,38.4,,1355.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,3309.75,75,,2647.8,percent of total billed charges,75% of total billed charges for outpatient setting,3309.75,75,,2647.8,percent of total billed charges,75% of total billed charges for outpatient setting,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,3309.75,75,,2647.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1544.55,35,,1235.64,percent of total billed charges,35% of total billed charges for outpatient setting,3442.14,78,,2753.712,percent of total billed charges,78% of total billed charges for outpatient setting,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,3089.1,70,,2471.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3309.75,75,,2647.8,percent of total billed charges,75% of total billed charges for outpatient setting,3662.79,83,,2930.232,percent of total billed charges,83% of total billed charges for outpatient setting,2206.5,50,,1765.2,percent of total billed charges,50% of total billed charges for outpatient setting,2206.5,50,,1765.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1728.48,39.17,,1382.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1544.55,3662.79,
POST PARTUM TUBAL,777858,CDM,360,RC,,,outpatient,,,1328,664,,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,509.95,38.4,,407.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,509.95,38.4,,407.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,464.8,35,,371.84,percent of total billed charges,35% of total billed charges for outpatient setting,1035.84,78,,828.672,percent of total billed charges,78% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,1102.24,83,,881.792,percent of total billed charges,83% of total billed charges for outpatient setting,664,50,,531.2,percent of total billed charges,50% of total billed charges for outpatient setting,664,50,,531.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,520.15,39.17,,416.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,464.8,1102.24,
STRYKER BLADES,777863,CDM,270,RC,,,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.85,175.13,
ORTHO PIN REMOVAL,777864,CDM,360,RC,,,outpatient,,,1433,716.5,,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,550.27,38.4,,440.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,550.27,38.4,,440.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,501.55,35,,401.24,percent of total billed charges,35% of total billed charges for outpatient setting,1117.74,78,,894.192,percent of total billed charges,78% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1189.39,83,,951.512,percent of total billed charges,83% of total billed charges for outpatient setting,716.5,50,,573.2,percent of total billed charges,50% of total billed charges for outpatient setting,716.5,50,,573.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,561.28,39.17,,449.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,501.55,1189.39,
ORIF,777867,CDM,360,RC,,,outpatient,,,3443,1721.5,,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1322.11,38.4,,1057.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1322.11,38.4,,1057.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,2582.25,75,,2065.8,percent of total billed charges,75% of total billed charges for outpatient setting,2582.25,75,,2065.8,percent of total billed charges,75% of total billed charges for outpatient setting,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,2582.25,75,,2065.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1205.05,35,,964.04,percent of total billed charges,35% of total billed charges for outpatient setting,2685.54,78,,2148.432,percent of total billed charges,78% of total billed charges for outpatient setting,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,2410.1,70,,1928.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2582.25,75,,2065.8,percent of total billed charges,75% of total billed charges for outpatient setting,2857.69,83,,2286.152,percent of total billed charges,83% of total billed charges for outpatient setting,1721.5,50,,1377.2,percent of total billed charges,50% of total billed charges for outpatient setting,1721.5,50,,1377.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1348.55,39.17,,1078.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1205.05,2857.69,
PLANTAR FASCIETOMY,777872,CDM,360,RC,,,outpatient,,,736,368,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.62,38.4,,226.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,282.62,38.4,,226.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,257.6,35,,206.08,percent of total billed charges,35% of total billed charges for outpatient setting,574.08,78,,459.264,percent of total billed charges,78% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,610.88,83,,488.704,percent of total billed charges,83% of total billed charges for outpatient setting,368,50,,294.4,percent of total billed charges,50% of total billed charges for outpatient setting,368,50,,294.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288.27,39.17,,230.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,257.6,610.88,
SHOULDER NEER PROC.,777875,CDM,360,RC,,,outpatient,,,2044,1022,,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,784.9,38.4,,627.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,784.9,38.4,,627.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,1533,75,,1226.4,percent of total billed charges,75% of total billed charges for outpatient setting,1533,75,,1226.4,percent of total billed charges,75% of total billed charges for outpatient setting,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,1533,75,,1226.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,715.4,35,,572.32,percent of total billed charges,35% of total billed charges for outpatient setting,1594.32,78,,1275.456,percent of total billed charges,78% of total billed charges for outpatient setting,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,1430.8,70,,1144.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1533,75,,1226.4,percent of total billed charges,75% of total billed charges for outpatient setting,1696.52,83,,1357.216,percent of total billed charges,83% of total billed charges for outpatient setting,1022,50,,817.6,percent of total billed charges,50% of total billed charges for outpatient setting,1022,50,,817.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.6,39.17,,640.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,715.4,1696.52,
BIL HUMEROUS ORIF,777878,CDM,360,RC,,,outpatient,,,3671,1835.5,,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1409.66,38.4,,1127.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1409.66,38.4,,1127.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,2753.25,75,,2202.6,percent of total billed charges,75% of total billed charges for outpatient setting,2753.25,75,,2202.6,percent of total billed charges,75% of total billed charges for outpatient setting,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,2753.25,75,,2202.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1284.85,35,,1027.88,percent of total billed charges,35% of total billed charges for outpatient setting,2863.38,78,,2290.704,percent of total billed charges,78% of total billed charges for outpatient setting,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,2569.7,70,,2055.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2753.25,75,,2202.6,percent of total billed charges,75% of total billed charges for outpatient setting,3046.93,83,,2437.544,percent of total billed charges,83% of total billed charges for outpatient setting,1835.5,50,,1468.4,percent of total billed charges,50% of total billed charges for outpatient setting,1835.5,50,,1468.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1437.85,39.17,,1150.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1284.85,3046.93,
HUMEROUS ORIF,777879,CDM,360,RC,,,outpatient,,,3458,1729,,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1327.87,38.4,,1062.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1327.87,38.4,,1062.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,2593.5,75,,2074.8,percent of total billed charges,75% of total billed charges for outpatient setting,2593.5,75,,2074.8,percent of total billed charges,75% of total billed charges for outpatient setting,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,2593.5,75,,2074.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1210.3,35,,968.24,percent of total billed charges,35% of total billed charges for outpatient setting,2697.24,78,,2157.792,percent of total billed charges,78% of total billed charges for outpatient setting,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,2420.6,70,,1936.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2593.5,75,,2074.8,percent of total billed charges,75% of total billed charges for outpatient setting,2870.14,83,,2296.112,percent of total billed charges,83% of total billed charges for outpatient setting,1729,50,,1383.2,percent of total billed charges,50% of total billed charges for outpatient setting,1729,50,,1383.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1354.43,39.17,,1083.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1210.3,2870.14,
ORIF ANKLE,777882,CDM,360,RC,,,outpatient,,,4391,2195.5,,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1686.14,38.4,,1348.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1686.14,38.4,,1348.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,3293.25,75,,2634.6,percent of total billed charges,75% of total billed charges for outpatient setting,3293.25,75,,2634.6,percent of total billed charges,75% of total billed charges for outpatient setting,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,3293.25,75,,2634.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1536.85,35,,1229.48,percent of total billed charges,35% of total billed charges for outpatient setting,3424.98,78,,2739.984,percent of total billed charges,78% of total billed charges for outpatient setting,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,3073.7,70,,2458.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3293.25,75,,2634.6,percent of total billed charges,75% of total billed charges for outpatient setting,3644.53,83,,2915.624,percent of total billed charges,83% of total billed charges for outpatient setting,2195.5,50,,1756.4,percent of total billed charges,50% of total billed charges for outpatient setting,2195.5,50,,1756.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1719.86,39.17,,1375.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1536.85,3644.53,
NASOPHARINGSOCOPY,777888,CDM,360,RC,,,outpatient,,,466,233,,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.1,35,,130.48,percent of total billed charges,35% of total billed charges for outpatient setting,363.48,78,,290.784,percent of total billed charges,78% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,386.78,83,,309.424,percent of total billed charges,83% of total billed charges for outpatient setting,233,50,,186.4,percent of total billed charges,50% of total billed charges for outpatient setting,233,50,,186.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.52,39.17,,146.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,163.1,386.78,
HEMI ARTHROPLASTY,777894,CDM,360,RC,,,outpatient,,,3654,1827,,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1403.14,38.4,,1122.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1403.14,38.4,,1122.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,2740.5,75,,2192.4,percent of total billed charges,75% of total billed charges for outpatient setting,2740.5,75,,2192.4,percent of total billed charges,75% of total billed charges for outpatient setting,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,2740.5,75,,2192.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1278.9,35,,1023.12,percent of total billed charges,35% of total billed charges for outpatient setting,2850.12,78,,2280.096,percent of total billed charges,78% of total billed charges for outpatient setting,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,2557.8,70,,2046.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2740.5,75,,2192.4,percent of total billed charges,75% of total billed charges for outpatient setting,3032.82,83,,2426.256,percent of total billed charges,83% of total billed charges for outpatient setting,1827,50,,1461.6,percent of total billed charges,50% of total billed charges for outpatient setting,1827,50,,1461.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1431.2,39.17,,1144.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1278.9,3032.82,
FLEX SIG BX FORCEP,777896,CDM,360,RC,,,outpatient,,,816,408,,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,313.34,38.4,,250.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,313.34,38.4,,250.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,612,75,,489.6,percent of total billed charges,75% of total billed charges for outpatient setting,612,75,,489.6,percent of total billed charges,75% of total billed charges for outpatient setting,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,612,75,,489.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,285.6,35,,228.48,percent of total billed charges,35% of total billed charges for outpatient setting,636.48,78,,509.184,percent of total billed charges,78% of total billed charges for outpatient setting,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,571.2,70,,456.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,612,75,,489.6,percent of total billed charges,75% of total billed charges for outpatient setting,677.28,83,,541.824,percent of total billed charges,83% of total billed charges for outpatient setting,408,50,,326.4,percent of total billed charges,50% of total billed charges for outpatient setting,408,50,,326.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,319.61,39.17,,255.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,285.6,677.28,
LOOP ELECTRODE,777898,CDM,270,RC,,,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,71.38,
TOTAL KNEE,777903,CDM,360,RC,,,outpatient,,,5792,2896,,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2224.13,38.4,,1779.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2224.13,38.4,,1779.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,4344,75,,3475.2,percent of total billed charges,75% of total billed charges for outpatient setting,4344,75,,3475.2,percent of total billed charges,75% of total billed charges for outpatient setting,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,4344,75,,3475.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2027.2,35,,1621.76,percent of total billed charges,35% of total billed charges for outpatient setting,4517.76,78,,3614.208,percent of total billed charges,78% of total billed charges for outpatient setting,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,4054.4,70,,3243.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4344,75,,3475.2,percent of total billed charges,75% of total billed charges for outpatient setting,4807.36,83,,3845.888,percent of total billed charges,83% of total billed charges for outpatient setting,2896,50,,2316.8,percent of total billed charges,50% of total billed charges for outpatient setting,2896,50,,2316.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2268.61,39.17,,1814.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2027.2,4807.36,
CLOSED REDUCTION,777908,CDM,360,RC,,,outpatient,,,764,382,,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.38,38.4,,234.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,293.38,38.4,,234.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,267.4,35,,213.92,percent of total billed charges,35% of total billed charges for outpatient setting,595.92,78,,476.736,percent of total billed charges,78% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,634.12,83,,507.296,percent of total billed charges,83% of total billed charges for outpatient setting,382,50,,305.6,percent of total billed charges,50% of total billed charges for outpatient setting,382,50,,305.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.25,39.17,,239.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,267.4,634.12,
LEEP PROCEDURE,777909,CDM,360,RC,,,outpatient,,,1422,711,,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,546.05,38.4,,436.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,546.05,38.4,,436.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,1066.5,75,,853.2,percent of total billed charges,75% of total billed charges for outpatient setting,1066.5,75,,853.2,percent of total billed charges,75% of total billed charges for outpatient setting,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,1066.5,75,,853.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,497.7,35,,398.16,percent of total billed charges,35% of total billed charges for outpatient setting,1109.16,78,,887.328,percent of total billed charges,78% of total billed charges for outpatient setting,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,995.4,70,,796.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1066.5,75,,853.2,percent of total billed charges,75% of total billed charges for outpatient setting,1180.26,83,,944.208,percent of total billed charges,83% of total billed charges for outpatient setting,711,50,,568.8,percent of total billed charges,50% of total billed charges for outpatient setting,711,50,,568.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,556.97,39.17,,445.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,497.7,1180.26,
ELBOW ARTHROSCOPY,777911,CDM,360,RC,,,outpatient,,,3749,1874.5,,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1439.62,38.4,,1151.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1439.62,38.4,,1151.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,2811.75,75,,2249.4,percent of total billed charges,75% of total billed charges for outpatient setting,2811.75,75,,2249.4,percent of total billed charges,75% of total billed charges for outpatient setting,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,2811.75,75,,2249.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1312.15,35,,1049.72,percent of total billed charges,35% of total billed charges for outpatient setting,2924.22,78,,2339.376,percent of total billed charges,78% of total billed charges for outpatient setting,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,2624.3,70,,2099.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2811.75,75,,2249.4,percent of total billed charges,75% of total billed charges for outpatient setting,3111.67,83,,2489.336,percent of total billed charges,83% of total billed charges for outpatient setting,1874.5,50,,1499.6,percent of total billed charges,50% of total billed charges for outpatient setting,1874.5,50,,1499.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1468.41,39.17,,1174.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1312.15,3111.67,
A-1 PULLEY RELEASE,777912,CDM,360,RC,,,outpatient,,,1585,792.5,,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,554.75,35,,443.8,percent of total billed charges,35% of total billed charges for outpatient setting,1236.3,78,,989.04,percent of total billed charges,78% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1315.55,83,,1052.44,percent of total billed charges,83% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,620.81,39.17,,496.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,554.75,1315.55,
MORTON NEUROMA,777913,CDM,360,RC,,,outpatient,,,1365,682.5,,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,524.16,38.4,,419.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,524.16,38.4,,419.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,477.75,35,,382.2,percent of total billed charges,35% of total billed charges for outpatient setting,1064.7,78,,851.76,percent of total billed charges,78% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,1132.95,83,,906.36,percent of total billed charges,83% of total billed charges for outpatient setting,682.5,50,,546,percent of total billed charges,50% of total billed charges for outpatient setting,682.5,50,,546,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,534.64,39.17,,427.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,477.75,1132.95,
OB OF VULVA CONDYLOM,777929,CDM,360,RC,,,outpatient,,,1274,637,,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,489.22,38.4,,391.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,489.22,38.4,,391.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,445.9,35,,356.72,percent of total billed charges,35% of total billed charges for outpatient setting,993.72,78,,794.976,percent of total billed charges,78% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,1057.42,83,,845.936,percent of total billed charges,83% of total billed charges for outpatient setting,637,50,,509.6,percent of total billed charges,50% of total billed charges for outpatient setting,637,50,,509.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,499,39.17,,399.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,445.9,1057.42,
ORIF WITH HIP PINNIN,777930,CDM,360,RC,,,outpatient,,,3391,1695.5,,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1302.14,38.4,,1041.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1302.14,38.4,,1041.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,2543.25,75,,2034.6,percent of total billed charges,75% of total billed charges for outpatient setting,2543.25,75,,2034.6,percent of total billed charges,75% of total billed charges for outpatient setting,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,2543.25,75,,2034.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1186.85,35,,949.48,percent of total billed charges,35% of total billed charges for outpatient setting,2644.98,78,,2115.984,percent of total billed charges,78% of total billed charges for outpatient setting,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,2373.7,70,,1898.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2543.25,75,,2034.6,percent of total billed charges,75% of total billed charges for outpatient setting,2814.53,83,,2251.624,percent of total billed charges,83% of total billed charges for outpatient setting,1695.5,50,,1356.4,percent of total billed charges,50% of total billed charges for outpatient setting,1695.5,50,,1356.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1328.18,39.17,,1062.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1186.85,2814.53,
ULNER NERVE TRANSPOS,777931,CDM,360,RC,,,outpatient,,,774,387,,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,297.22,38.4,,237.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.22,38.4,,237.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,580.5,75,,464.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.5,75,,464.4,percent of total billed charges,75% of total billed charges for outpatient setting,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,580.5,75,,464.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.9,35,,216.72,percent of total billed charges,35% of total billed charges for outpatient setting,603.72,78,,482.976,percent of total billed charges,78% of total billed charges for outpatient setting,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,541.8,70,,433.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,580.5,75,,464.4,percent of total billed charges,75% of total billed charges for outpatient setting,642.42,83,,513.936,percent of total billed charges,83% of total billed charges for outpatient setting,387,50,,309.6,percent of total billed charges,50% of total billed charges for outpatient setting,387,50,,309.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.16,39.17,,242.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,270.9,642.42,
TOTAL HIP,777932,CDM,360,RC,,,outpatient,,,5874,2937,,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2255.62,38.4,,1804.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2255.62,38.4,,1804.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2055.9,35,,1644.72,percent of total billed charges,35% of total billed charges for outpatient setting,4581.72,78,,3665.376,percent of total billed charges,78% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4875.42,83,,3900.336,percent of total billed charges,83% of total billed charges for outpatient setting,2937,50,,2349.6,percent of total billed charges,50% of total billed charges for outpatient setting,2937,50,,2349.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2300.73,39.17,,1840.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2055.9,4875.42,
CANNULATED SCREW,777934,CDM,278,RC,C1713,HCPCS,both,,,711,355.5,,497.7,70,,398.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,273.02,38.4,,218.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273.02,38.4,,218.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,497.7,70,,398.16,percent of total billed charges,70% of billed charges for implant carveouts,497.7,70,,398.16,percent of total billed charges,70% of billed charges for implant carveouts,497.7,70,,398.16,percent of total billed charges,70% of billed charges for implant carveouts,568.8,80,,455.04,percent of total billed charges,80% of billed charges for implant carveouts,568.8,80,,455.04,percent of total billed charges,80% of billed charges for implant carveouts,497.7,70,,398.16,percent of total billed charges,70% of billed charges for implant carveouts,568.8,80,,455.04,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,248.85,35,,199.08,percent of total billed charges,35% of total billed charges for outpatient setting,554.58,78,,443.664,percent of total billed charges,78% of total billed charges for outpatient setting,497.7,70,,398.16,percent of total billed charges,70% of total billed charges for outpatient setting,497.7,70,,398.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,533.25,75,,426.6,percent of total billed charges,75% of total billed charges for outpatient setting,590.13,83,,472.104,percent of total billed charges,83% of total billed charges for outpatient setting,355.5,50,,284.4,percent of total billed charges,50% of total billed charges for outpatient setting,355.5,50,,284.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,278.48,39.17,,222.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,248.85,590.13,
OUTPATIENT MINOR CHG,777937,CDM,360,RC,,,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
BILATERAL ARTHO KNEE,777939,CDM,360,RC,,,outpatient,,,3093,1546.5,,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1187.71,38.4,,950.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1187.71,38.4,,950.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,2319.75,75,,1855.8,percent of total billed charges,75% of total billed charges for outpatient setting,2319.75,75,,1855.8,percent of total billed charges,75% of total billed charges for outpatient setting,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,2319.75,75,,1855.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1082.55,35,,866.04,percent of total billed charges,35% of total billed charges for outpatient setting,2412.54,78,,1930.032,percent of total billed charges,78% of total billed charges for outpatient setting,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,2165.1,70,,1732.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2319.75,75,,1855.8,percent of total billed charges,75% of total billed charges for outpatient setting,2567.19,83,,2053.752,percent of total billed charges,83% of total billed charges for outpatient setting,1546.5,50,,1237.2,percent of total billed charges,50% of total billed charges for outpatient setting,1546.5,50,,1237.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1211.46,39.17,,969.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1082.55,2567.19,
PAIN MNGT. BIER BLOC,777953,CDM,360,RC,,,outpatient,,,570,285,,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,218.88,38.4,,175.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,218.88,38.4,,175.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,427.5,75,,342,percent of total billed charges,75% of total billed charges for outpatient setting,427.5,75,,342,percent of total billed charges,75% of total billed charges for outpatient setting,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,427.5,75,,342,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,199.5,35,,159.6,percent of total billed charges,35% of total billed charges for outpatient setting,444.6,78,,355.68,percent of total billed charges,78% of total billed charges for outpatient setting,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,399,70,,319.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,427.5,75,,342,percent of total billed charges,75% of total billed charges for outpatient setting,473.1,83,,378.48,percent of total billed charges,83% of total billed charges for outpatient setting,285,50,,228,percent of total billed charges,50% of total billed charges for outpatient setting,285,50,,228,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.26,39.17,,178.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,199.5,473.1,
REM.COMP.HIP PLTS/SC,777957,CDM,360,RC,,,outpatient,,,2380,1190,,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.92,38.4,,731.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,913.92,38.4,,731.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,1785,75,,1428,percent of total billed charges,75% of total billed charges for outpatient setting,1785,75,,1428,percent of total billed charges,75% of total billed charges for outpatient setting,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,1785,75,,1428,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,833,35,,666.4,percent of total billed charges,35% of total billed charges for outpatient setting,1856.4,78,,1485.12,percent of total billed charges,78% of total billed charges for outpatient setting,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,1666,70,,1332.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1785,75,,1428,percent of total billed charges,75% of total billed charges for outpatient setting,1975.4,83,,1580.32,percent of total billed charges,83% of total billed charges for outpatient setting,1190,50,,952,percent of total billed charges,50% of total billed charges for outpatient setting,1190,50,,952,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,932.2,39.17,,745.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,833,1975.4,
I M NAILING SHOULDER,777961,CDM,360,RC,,,outpatient,,,2640,1320,,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1013.76,38.4,,811.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1013.76,38.4,,811.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,1980,75,,1584,percent of total billed charges,75% of total billed charges for outpatient setting,1980,75,,1584,percent of total billed charges,75% of total billed charges for outpatient setting,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,1980,75,,1584,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,924,35,,739.2,percent of total billed charges,35% of total billed charges for outpatient setting,2059.2,78,,1647.36,percent of total billed charges,78% of total billed charges for outpatient setting,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,1848,70,,1478.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1980,75,,1584,percent of total billed charges,75% of total billed charges for outpatient setting,2191.2,83,,1752.96,percent of total billed charges,83% of total billed charges for outpatient setting,1320,50,,1056,percent of total billed charges,50% of total billed charges for outpatient setting,1320,50,,1056,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1034.04,39.17,,827.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,924,2191.2,
RETROCELE,777962,CDM,360,RC,,,outpatient,,,1228,614,,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,471.55,38.4,,377.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,471.55,38.4,,377.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,921,75,,736.8,percent of total billed charges,75% of total billed charges for outpatient setting,921,75,,736.8,percent of total billed charges,75% of total billed charges for outpatient setting,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,921,75,,736.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,429.8,35,,343.84,percent of total billed charges,35% of total billed charges for outpatient setting,957.84,78,,766.272,percent of total billed charges,78% of total billed charges for outpatient setting,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,859.6,70,,687.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,921,75,,736.8,percent of total billed charges,75% of total billed charges for outpatient setting,1019.24,83,,815.392,percent of total billed charges,83% of total billed charges for outpatient setting,614,50,,491.2,percent of total billed charges,50% of total billed charges for outpatient setting,614,50,,491.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,480.98,39.17,,384.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,429.8,1019.24,
FEMUR IM NAILING,777963,CDM,360,RC,,,outpatient,,,3854,1927,,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1479.94,38.4,,1183.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1479.94,38.4,,1183.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1348.9,35,,1079.12,percent of total billed charges,35% of total billed charges for outpatient setting,3006.12,78,,2404.896,percent of total billed charges,78% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,3198.82,83,,2559.056,percent of total billed charges,83% of total billed charges for outpatient setting,1927,50,,1541.6,percent of total billed charges,50% of total billed charges for outpatient setting,1927,50,,1541.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1509.54,39.17,,1207.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1348.9,3198.82,
SYNOVECTOMY ELBOW,777964,CDM,360,RC,,,outpatient,,,1644,822,,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,631.3,38.4,,505.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,631.3,38.4,,505.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,1233,75,,986.4,percent of total billed charges,75% of total billed charges for outpatient setting,1233,75,,986.4,percent of total billed charges,75% of total billed charges for outpatient setting,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,1233,75,,986.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,575.4,35,,460.32,percent of total billed charges,35% of total billed charges for outpatient setting,1282.32,78,,1025.856,percent of total billed charges,78% of total billed charges for outpatient setting,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,1150.8,70,,920.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1233,75,,986.4,percent of total billed charges,75% of total billed charges for outpatient setting,1364.52,83,,1091.616,percent of total billed charges,83% of total billed charges for outpatient setting,822,50,,657.6,percent of total billed charges,50% of total billed charges for outpatient setting,822,50,,657.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.93,39.17,,515.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,575.4,1364.52,
PAIN MNGT EPID/NO NR,777967,CDM,360,RC,,,outpatient,,,729,364.5,,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255.15,35,,204.12,percent of total billed charges,35% of total billed charges for outpatient setting,568.62,78,,454.896,percent of total billed charges,78% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,605.07,83,,484.056,percent of total billed charges,83% of total billed charges for outpatient setting,364.5,50,,291.6,percent of total billed charges,50% of total billed charges for outpatient setting,364.5,50,,291.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,285.54,39.17,,228.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,255.15,605.07,
PAIN MNGT SYBLK/NONR,777969,CDM,360,RC,,,outpatient,,,593,296.5,,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,227.71,38.4,,182.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,227.71,38.4,,182.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,444.75,75,,355.8,percent of total billed charges,75% of total billed charges for outpatient setting,444.75,75,,355.8,percent of total billed charges,75% of total billed charges for outpatient setting,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,444.75,75,,355.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,207.55,35,,166.04,percent of total billed charges,35% of total billed charges for outpatient setting,462.54,78,,370.032,percent of total billed charges,78% of total billed charges for outpatient setting,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,415.1,70,,332.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,444.75,75,,355.8,percent of total billed charges,75% of total billed charges for outpatient setting,492.19,83,,393.752,percent of total billed charges,83% of total billed charges for outpatient setting,296.5,50,,237.2,percent of total billed charges,50% of total billed charges for outpatient setting,296.5,50,,237.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.26,39.17,,185.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,207.55,492.19,
OPEN FEEDING TUBE,777971,CDM,360,RC,,,outpatient,,,764,382,,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.38,38.4,,234.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,293.38,38.4,,234.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,267.4,35,,213.92,percent of total billed charges,35% of total billed charges for outpatient setting,595.92,78,,476.736,percent of total billed charges,78% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,534.8,70,,427.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,573,75,,458.4,percent of total billed charges,75% of total billed charges for outpatient setting,634.12,83,,507.296,percent of total billed charges,83% of total billed charges for outpatient setting,382,50,,305.6,percent of total billed charges,50% of total billed charges for outpatient setting,382,50,,305.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.25,39.17,,239.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,267.4,634.12,
XEROFORM 5 X9,777986,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
STELLATE GANG BLOCK,777988,CDM,360,RC,,,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,229.25,543.65,
ORIF TIBIA NAILING,777989,CDM,360,RC,,,outpatient,,,6890,3445,,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2645.76,38.4,,2116.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2645.76,38.4,,2116.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,5167.5,75,,4134,percent of total billed charges,75% of total billed charges for outpatient setting,5167.5,75,,4134,percent of total billed charges,75% of total billed charges for outpatient setting,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,5167.5,75,,4134,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2411.5,35,,1929.2,percent of total billed charges,35% of total billed charges for outpatient setting,5374.2,78,,4299.36,percent of total billed charges,78% of total billed charges for outpatient setting,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,4823,70,,3858.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5167.5,75,,4134,percent of total billed charges,75% of total billed charges for outpatient setting,5718.7,83,,4574.96,percent of total billed charges,83% of total billed charges for outpatient setting,3445,50,,2756,percent of total billed charges,50% of total billed charges for outpatient setting,3445,50,,2756,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2698.68,39.17,,2158.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2411.5,5718.7,
SIMPULSE IRRIGATION,778001,CDM,270,RC,,,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
LAP IRRIGATION SET,778002,CDM,270,RC,,,outpatient,,,434,217,,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.66,38.4,,133.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.66,38.4,,133.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,325.5,75,,260.4,percent of total billed charges,75% of total billed charges for outpatient setting,325.5,75,,260.4,percent of total billed charges,75% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,325.5,75,,260.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.9,35,,121.52,percent of total billed charges,35% of total billed charges for outpatient setting,338.52,78,,270.816,percent of total billed charges,78% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,325.5,75,,260.4,percent of total billed charges,75% of total billed charges for outpatient setting,360.22,83,,288.176,percent of total billed charges,83% of total billed charges for outpatient setting,217,50,,173.6,percent of total billed charges,50% of total billed charges for outpatient setting,217,50,,173.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.99,39.17,,135.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,151.9,360.22,
THORACENTESIS W/ IMAGING GUIDANCE,778003,CDM,360,RC,,,outpatient,,,1656,828,,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,635.9,38.4,,508.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,635.9,38.4,,508.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,1242,75,,993.6,percent of total billed charges,75% of total billed charges for outpatient setting,1242,75,,993.6,percent of total billed charges,75% of total billed charges for outpatient setting,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,1242,75,,993.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,579.6,35,,463.68,percent of total billed charges,35% of total billed charges for outpatient setting,1291.68,78,,1033.344,percent of total billed charges,78% of total billed charges for outpatient setting,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,1159.2,70,,927.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1242,75,,993.6,percent of total billed charges,75% of total billed charges for outpatient setting,1374.48,83,,1099.584,percent of total billed charges,83% of total billed charges for outpatient setting,828,50,,662.4,percent of total billed charges,50% of total billed charges for outpatient setting,828,50,,662.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,648.62,39.17,,518.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,579.6,1374.48,
SURGICAL CLIPPER BLD,778007,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
DRAIN JP 7MM,778013,CDM,270,RC,,,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.4,69.72,
K WIRE AR 8943-01,778014,CDM,278,RC,C1713,HCPCS,both,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,75,,112,percent of total billed charges,75% of total billed charges for outpatient setting,140,75,,112,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,75,,112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49,35,,39.2,percent of total billed charges,35% of total billed charges for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.84,39.17,,43.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49,140,
WASHER AR 8870W 7.0 MM,778015,CDM,278,RC,C1713,HCPCS,both,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,70,,76.8,percent of total billed charges,70% of total billed charges for outpatient setting,96,70,,76.8,percent of total billed charges,70% of total billed charges for outpatient setting,96,70,,76.8,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,70,,76.8,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,35,,26.88,percent of total billed charges,35% of total billed charges for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.6,39.17,,30.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.6,96,
CANNULATED DRILL BIT AR 8840C-40 4.0X55M,778016,CDM,278,RC,C1713,HCPCS,both,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,35,,273,percent of total billed charges,35% of total billed charges for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.89,39.17,,305.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,341.25,809.25,
CANNULATED DRILL BIT AR 8737-50 2.7 MM,778017,CDM,278,RC,C1713,HCPCS,both,,,525,262.5,,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.5,70,,294,percent of total billed charges,70% of billed charges for implant carveouts,367.5,70,,294,percent of total billed charges,70% of billed charges for implant carveouts,367.5,70,,294,percent of total billed charges,70% of billed charges for implant carveouts,420,80,,336,percent of total billed charges,80% of billed charges for implant carveouts,420,80,,336,percent of total billed charges,80% of billed charges for implant carveouts,367.5,70,,294,percent of total billed charges,70% of billed charges for implant carveouts,420,80,,336,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.75,35,,147,percent of total billed charges,35% of total billed charges for outpatient setting,409.5,78,,327.6,percent of total billed charges,78% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,435.75,83,,348.6,percent of total billed charges,83% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.63,39.17,,164.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,183.75,435.75,
PROFILE DRILL3.5 MM AR 8737-47,778018,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
K WIRE AR 8737-41,778019,CDM,278,RC,C1713,HCPCS,both,,,220,110,,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77,35,,61.6,percent of total billed charges,35% of total billed charges for outpatient setting,171.6,78,,137.28,percent of total billed charges,78% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,182.6,83,,146.08,percent of total billed charges,83% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.17,39.17,,68.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,77,220,
COMPRESSION  FULL THREAD SCREW 3.5X18 MM,778020,CDM,278,RC,C1713,HCPCS,both,,,1750,875,,1225,70,,980,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672,38.4,,537.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,38.4,,537.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1225,70,,980,percent of total billed charges,70% of billed charges for implant carveouts,1225,70,,980,percent of total billed charges,70% of billed charges for implant carveouts,1225,70,,980,percent of total billed charges,70% of billed charges for implant carveouts,1400,80,,1120,percent of total billed charges,80% of billed charges for implant carveouts,1400,80,,1120,percent of total billed charges,80% of billed charges for implant carveouts,1225,70,,980,percent of total billed charges,70% of billed charges for implant carveouts,1400,80,,1120,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,612.5,35,,490,percent of total billed charges,35% of total billed charges for outpatient setting,1365,78,,1092,percent of total billed charges,78% of total billed charges for outpatient setting,1225,70,,980,percent of total billed charges,70% of total billed charges for outpatient setting,1225,70,,980,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1312.5,75,,1050,percent of total billed charges,75% of total billed charges for outpatient setting,1452.5,83,,1162,percent of total billed charges,83% of total billed charges for outpatient setting,875,50,,700,percent of total billed charges,50% of total billed charges for outpatient setting,875,50,,700,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,685.44,39.17,,548.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,612.5,1452.5,
CANNULATED SH THREAD AR 8840C-40 4.0X40,778021,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
T. TUBE,778023,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
EXTERNAL FIXATION,778024,CDM,360,RC,,,outpatient,,,7125,3562.5,,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2736,38.4,,2188.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2736,38.4,,2188.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,5343.75,75,,4275,percent of total billed charges,75% of total billed charges for outpatient setting,5343.75,75,,4275,percent of total billed charges,75% of total billed charges for outpatient setting,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,5343.75,75,,4275,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2493.75,35,,1995,percent of total billed charges,35% of total billed charges for outpatient setting,5557.5,78,,4446,percent of total billed charges,78% of total billed charges for outpatient setting,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,4987.5,70,,3990,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5343.75,75,,4275,percent of total billed charges,75% of total billed charges for outpatient setting,5913.75,83,,4731,percent of total billed charges,83% of total billed charges for outpatient setting,3562.5,50,,2850,percent of total billed charges,50% of total billed charges for outpatient setting,3562.5,50,,2850,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2790.72,39.17,,2232.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2493.75,5913.75,
RADIAL HEAD FX,778026,CDM,360,RC,,,outpatient,,,1732,866,,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,665.09,38.4,,532.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,665.09,38.4,,532.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,1299,75,,1039.2,percent of total billed charges,75% of total billed charges for outpatient setting,1299,75,,1039.2,percent of total billed charges,75% of total billed charges for outpatient setting,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,1299,75,,1039.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,606.2,35,,484.96,percent of total billed charges,35% of total billed charges for outpatient setting,1350.96,78,,1080.768,percent of total billed charges,78% of total billed charges for outpatient setting,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,1212.4,70,,969.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1299,75,,1039.2,percent of total billed charges,75% of total billed charges for outpatient setting,1437.56,83,,1150.048,percent of total billed charges,83% of total billed charges for outpatient setting,866,50,,692.8,percent of total billed charges,50% of total billed charges for outpatient setting,866,50,,692.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,678.39,39.17,,542.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,606.2,1437.56,
WRIST ARTHROSCOPY,778027,CDM,360,RC,,,outpatient,,,2138,1069,,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.3,35,,598.64,percent of total billed charges,35% of total billed charges for outpatient setting,1667.64,78,,1334.112,percent of total billed charges,78% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1774.54,83,,1419.632,percent of total billed charges,83% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,837.41,39.17,,669.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,748.3,1774.54,
CANNULATED SH THREAD AR 8840C-40 4.0X 40,778028,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
CANNULATED SH THREAD AR 8840C-40 4.0X 60,778029,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
DISPOSABLE KIT AR 8978 DS-01,778030,CDM,278,RC,C1713,HCPCS,both,,,1380,690,,966,70,,772.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,529.92,38.4,,423.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,529.92,38.4,,423.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,966,70,,772.8,percent of total billed charges,70% of billed charges for implant carveouts,966,70,,772.8,percent of total billed charges,70% of billed charges for implant carveouts,966,70,,772.8,percent of total billed charges,70% of billed charges for implant carveouts,1104,80,,883.2,percent of total billed charges,80% of billed charges for implant carveouts,1104,80,,883.2,percent of total billed charges,80% of billed charges for implant carveouts,966,70,,772.8,percent of total billed charges,70% of billed charges for implant carveouts,1104,80,,883.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483,35,,386.4,percent of total billed charges,35% of total billed charges for outpatient setting,1076.4,78,,861.12,percent of total billed charges,78% of total billed charges for outpatient setting,966,70,,772.8,percent of total billed charges,70% of total billed charges for outpatient setting,966,70,,772.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1035,75,,828,percent of total billed charges,75% of total billed charges for outpatient setting,1145.4,83,,916.32,percent of total billed charges,83% of total billed charges for outpatient setting,690,50,,552,percent of total billed charges,50% of total billed charges for outpatient setting,690,50,,552,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.52,39.17,,432.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,483,1145.4,
K WIRE AR 8741-14,778031,CDM,278,RC,C1713,HCPCS,both,,,220,110,,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,220,70,,176,percent of total billed charges,70% of total billed charges for outpatient setting,220,75,,176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77,35,,61.6,percent of total billed charges,35% of total billed charges for outpatient setting,171.6,78,,137.28,percent of total billed charges,78% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,182.6,83,,146.08,percent of total billed charges,83% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.17,39.17,,68.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,77,220,
BEVELED COMPRESSION  FULL THREAD SCREW,778032,CDM,278,RC,C1713,HCPCS,both,,,3980,1990,,2786,70,,2228.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1528.32,38.4,,1222.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1528.32,38.4,,1222.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2786,70,,2228.8,percent of total billed charges,70% of billed charges for implant carveouts,2786,70,,2228.8,percent of total billed charges,70% of billed charges for implant carveouts,2786,70,,2228.8,percent of total billed charges,70% of billed charges for implant carveouts,3184,80,,2547.2,percent of total billed charges,80% of billed charges for implant carveouts,3184,80,,2547.2,percent of total billed charges,80% of billed charges for implant carveouts,2786,70,,2228.8,percent of total billed charges,70% of billed charges for implant carveouts,3184,80,,2547.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1393,35,,1114.4,percent of total billed charges,35% of total billed charges for outpatient setting,3104.4,78,,2483.52,percent of total billed charges,78% of total billed charges for outpatient setting,2786,70,,2228.8,percent of total billed charges,70% of total billed charges for outpatient setting,2786,70,,2228.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2985,75,,2388,percent of total billed charges,75% of total billed charges for outpatient setting,3303.4,83,,2642.72,percent of total billed charges,83% of total billed charges for outpatient setting,1990,50,,1592,percent of total billed charges,50% of total billed charges for outpatient setting,1990,50,,1592,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1558.89,39.17,,1247.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1393,3303.4,
PROFILE DRILL AR 8741-36S,778033,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
DX SWIVELOCK SL W/ FORKED E 3.5X18 MM,778034,CDM,278,RC,C1713,HCPCS,both,,,2100,1050,,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,735,35,,588,percent of total billed charges,35% of total billed charges for outpatient setting,1638,78,,1310.4,percent of total billed charges,78% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,1743,83,,1394.4,percent of total billed charges,83% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,822.53,39.17,,658.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,735,1743,
FIBERWIRE 4.0 AR - 7228,778035,CDM,278,RC,C1713,HCPCS,both,,,110,55,,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.5,35,,30.8,percent of total billed charges,35% of total billed charges for outpatient setting,85.8,78,,68.64,percent of total billed charges,78% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,91.3,83,,73.04,percent of total billed charges,83% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.08,39.17,,34.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.5,110,
SUTURE TAPE AR - 7506T,778036,CDM,278,RC,C1713,HCPCS,both,,,250.5,125.25,,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.19,38.4,,76.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96.19,38.4,,76.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,250.5,70,,200.4,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,70,,200.4,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,70,,200.4,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,70,,200.4,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.68,35,,70.144,percent of total billed charges,35% of total billed charges for outpatient setting,195.39,78,,156.312,percent of total billed charges,78% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.88,75,,150.304,percent of total billed charges,75% of total billed charges for outpatient setting,207.92,83,,166.336,percent of total billed charges,83% of total billed charges for outpatient setting,125.25,50,,100.2,percent of total billed charges,50% of total billed charges for outpatient setting,125.25,50,,100.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.11,39.17,,78.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.68,250.5,
TIGERLOOP AR 7534T,778037,CDM,278,RC,C1713,HCPCS,both,,,350,175,,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,75,,280,percent of total billed charges,75% of total billed charges for outpatient setting,350,75,,280,percent of total billed charges,75% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,75,,280,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.5,35,,98,percent of total billed charges,35% of total billed charges for outpatient setting,273,78,,218.4,percent of total billed charges,78% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,290.5,83,,232.4,percent of total billed charges,83% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.09,39.17,,109.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.5,350,
DX SWIVELOCK SL W/ FORKED EYELET,778038,CDM,278,RC,C1713,HCPCS,both,,,2100,1050,,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,1470,70,,1176,percent of total billed charges,70% of billed charges for implant carveouts,1680,80,,1344,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,735,35,,588,percent of total billed charges,35% of total billed charges for outpatient setting,1638,78,,1310.4,percent of total billed charges,78% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,1743,83,,1394.4,percent of total billed charges,83% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,822.53,39.17,,658.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,735,1743,
DRILL BIT 1.7MM  AR 8916-14,778039,CDM,278,RC,C1713,HCPCS,both,,,630,315,,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,241.92,38.4,,193.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.92,38.4,,193.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,441,70,,352.8,percent of total billed charges,70% of billed charges for implant carveouts,441,70,,352.8,percent of total billed charges,70% of billed charges for implant carveouts,441,70,,352.8,percent of total billed charges,70% of billed charges for implant carveouts,504,80,,403.2,percent of total billed charges,80% of billed charges for implant carveouts,504,80,,403.2,percent of total billed charges,80% of billed charges for implant carveouts,441,70,,352.8,percent of total billed charges,70% of billed charges for implant carveouts,504,80,,403.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.5,35,,176.4,percent of total billed charges,35% of total billed charges for outpatient setting,491.4,78,,393.12,percent of total billed charges,78% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,441,70,,352.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,472.5,75,,378,percent of total billed charges,75% of total billed charges for outpatient setting,522.9,83,,418.32,percent of total billed charges,83% of total billed charges for outpatient setting,315,50,,252,percent of total billed charges,50% of total billed charges for outpatient setting,315,50,,252,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.76,39.17,,197.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,220.5,522.9,
DRILL BIT 2.5 MM  AR 8916-06,778040,CDM,278,RC,C1713,HCPCS,both,,,795,397.5,,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,305.28,38.4,,244.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,305.28,38.4,,244.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,556.5,70,,445.2,percent of total billed charges,70% of billed charges for implant carveouts,556.5,70,,445.2,percent of total billed charges,70% of billed charges for implant carveouts,556.5,70,,445.2,percent of total billed charges,70% of billed charges for implant carveouts,636,80,,508.8,percent of total billed charges,80% of billed charges for implant carveouts,636,80,,508.8,percent of total billed charges,80% of billed charges for implant carveouts,556.5,70,,445.2,percent of total billed charges,70% of billed charges for implant carveouts,636,80,,508.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,278.25,35,,222.6,percent of total billed charges,35% of total billed charges for outpatient setting,620.1,78,,496.08,percent of total billed charges,78% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,596.25,75,,477,percent of total billed charges,75% of total billed charges for outpatient setting,659.85,83,,527.88,percent of total billed charges,83% of total billed charges for outpatient setting,397.5,50,,318,percent of total billed charges,50% of total billed charges for outpatient setting,397.5,50,,318,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,311.39,39.17,,249.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,278.25,659.85,
BASIC ORTHO CHARGE,778041,CDM,360,RC,,,outpatient,,,2962,1481,,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1137.41,38.4,,909.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1137.41,38.4,,909.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1036.7,35,,829.36,percent of total billed charges,35% of total billed charges for outpatient setting,2310.36,78,,1848.288,percent of total billed charges,78% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2458.46,83,,1966.768,percent of total billed charges,83% of total billed charges for outpatient setting,1481,50,,1184.8,percent of total billed charges,50% of total billed charges for outpatient setting,1481,50,,1184.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1160.16,39.17,,928.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1036.7,2458.46,
3 HOLE PLATE VOLAR LOCKING  AR 8916-03,778042,CDM,278,RC,C1713,HCPCS,both,,,9275,4637.5,,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3561.6,38.4,,2849.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3561.6,38.4,,2849.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6492.5,70,,5194,percent of total billed charges,70% of billed charges for implant carveouts,6492.5,70,,5194,percent of total billed charges,70% of billed charges for implant carveouts,6492.5,70,,5194,percent of total billed charges,70% of billed charges for implant carveouts,7420,80,,5936,percent of total billed charges,80% of billed charges for implant carveouts,7420,80,,5936,percent of total billed charges,80% of billed charges for implant carveouts,6492.5,70,,5194,percent of total billed charges,70% of billed charges for implant carveouts,7420,80,,5936,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3246.25,35,,2597,percent of total billed charges,35% of total billed charges for outpatient setting,7234.5,78,,5787.6,percent of total billed charges,78% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6956.25,75,,5565,percent of total billed charges,75% of total billed charges for outpatient setting,7698.25,83,,6158.6,percent of total billed charges,83% of total billed charges for outpatient setting,4637.5,50,,3710,percent of total billed charges,50% of total billed charges for outpatient setting,4637.5,50,,3710,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3632.83,39.17,,2906.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3246.25,7698.25,
HAND ASSISTED SPLEENECTOMY,778043,CDM,360,RC,,,outpatient,,,6102,3051,,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2343.17,38.4,,1874.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2343.17,38.4,,1874.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,4576.5,75,,3661.2,percent of total billed charges,75% of total billed charges for outpatient setting,4576.5,75,,3661.2,percent of total billed charges,75% of total billed charges for outpatient setting,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,4576.5,75,,3661.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2135.7,35,,1708.56,percent of total billed charges,35% of total billed charges for outpatient setting,4759.56,78,,3807.648,percent of total billed charges,78% of total billed charges for outpatient setting,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,4271.4,70,,3417.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4576.5,75,,3661.2,percent of total billed charges,75% of total billed charges for outpatient setting,5064.66,83,,4051.728,percent of total billed charges,83% of total billed charges for outpatient setting,3051,50,,2440.8,percent of total billed charges,50% of total billed charges for outpatient setting,3051,50,,2440.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2390.03,39.17,,1912.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2135.7,5064.66,
SCREW 3.5X18 MM CORTICAL AR 8935-18,778044,CDM,278,RC,C1713,HCPCS,both,,,300,150,,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.2,38.4,,92.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.2,38.4,,92.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,35,,84,percent of total billed charges,35% of total billed charges for outpatient setting,234,78,,187.2,percent of total billed charges,78% of total billed charges for outpatient setting,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225,75,,180,percent of total billed charges,75% of total billed charges for outpatient setting,249,83,,199.2,percent of total billed charges,83% of total billed charges for outpatient setting,150,50,,120,percent of total billed charges,50% of total billed charges for outpatient setting,150,50,,120,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.5,39.17,,94,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,105,300,
SCREW 2.4X18 MM CORTICAL AR 8916CX24-24,778045,CDM,278,RC,C1713,HCPCS,both,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.5,456.5,
SCREW 2.4X20 MM CORTICAL AR 8916CX24-20,778046,CDM,278,RC,C1713,HCPCS,both,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.5,456.5,
SCREW 2.4X22 MM LOCKING AR 8724VCL-22,778047,CDM,278,RC,C1713,HCPCS,both,,,1476,738,,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,516.6,35,,413.28,percent of total billed charges,35% of total billed charges for outpatient setting,1151.28,78,,921.024,percent of total billed charges,78% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1107,75,,885.6,percent of total billed charges,75% of total billed charges for outpatient setting,1225.08,83,,980.064,percent of total billed charges,83% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,578.12,39.17,,462.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,516.6,1225.08,
SCREW 2.4X18 MM LOCKING AR 8724VCL-18,778048,CDM,278,RC,C1713,HCPCS,both,,,3445,1722.5,,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1322.88,38.4,,1058.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1322.88,38.4,,1058.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2411.5,70,,1929.2,percent of total billed charges,70% of billed charges for implant carveouts,2411.5,70,,1929.2,percent of total billed charges,70% of billed charges for implant carveouts,2411.5,70,,1929.2,percent of total billed charges,70% of billed charges for implant carveouts,2756,80,,2204.8,percent of total billed charges,80% of billed charges for implant carveouts,2756,80,,2204.8,percent of total billed charges,80% of billed charges for implant carveouts,2411.5,70,,1929.2,percent of total billed charges,70% of billed charges for implant carveouts,2756,80,,2204.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1205.75,35,,964.6,percent of total billed charges,35% of total billed charges for outpatient setting,2687.1,78,,2149.68,percent of total billed charges,78% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2583.75,75,,2067,percent of total billed charges,75% of total billed charges for outpatient setting,2859.35,83,,2287.48,percent of total billed charges,83% of total billed charges for outpatient setting,1722.5,50,,1378,percent of total billed charges,50% of total billed charges for outpatient setting,1722.5,50,,1378,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1349.34,39.17,,1079.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1205.75,2859.35,
SCREW 2.4X20 MM LOCKING AR 8724VCL-20,778049,CDM,278,RC,C1713,HCPCS,both,,,1476,738,,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,516.6,35,,413.28,percent of total billed charges,35% of total billed charges for outpatient setting,1151.28,78,,921.024,percent of total billed charges,78% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1107,75,,885.6,percent of total billed charges,75% of total billed charges for outpatient setting,1225.08,83,,980.064,percent of total billed charges,83% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,578.12,39.17,,462.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,516.6,1225.08,
SCREW 2.4X24 MM LOCKING AR 8724VCL-24,778050,CDM,278,RC,C1713,HCPCS,both,,,1476,738,,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,566.78,38.4,,453.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,1033.2,70,,826.56,percent of total billed charges,70% of billed charges for implant carveouts,1180.8,80,,944.64,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,516.6,35,,413.28,percent of total billed charges,35% of total billed charges for outpatient setting,1151.28,78,,921.024,percent of total billed charges,78% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,1033.2,70,,826.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1107,75,,885.6,percent of total billed charges,75% of total billed charges for outpatient setting,1225.08,83,,980.064,percent of total billed charges,83% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,738,50,,590.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,578.12,39.17,,462.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,516.6,1225.08,
EPIDURAL STEROID INJECTION W/ GUIDANCE,778051,CDM,360,RC,,,outpatient,,,1700,850,,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,652.8,38.4,,522.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,652.8,38.4,,522.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,1275,75,,1020,percent of total billed charges,75% of total billed charges for outpatient setting,1275,75,,1020,percent of total billed charges,75% of total billed charges for outpatient setting,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,1275,75,,1020,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,595,35,,476,percent of total billed charges,35% of total billed charges for outpatient setting,1326,78,,1060.8,percent of total billed charges,78% of total billed charges for outpatient setting,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,1190,70,,952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1275,75,,1020,percent of total billed charges,75% of total billed charges for outpatient setting,1411,83,,1128.8,percent of total billed charges,83% of total billed charges for outpatient setting,850,50,,680,percent of total billed charges,50% of total billed charges for outpatient setting,850,50,,680,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,665.86,39.17,,532.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,595,1411,
SCREW 3.5X13 MM CORTICAL AR 8935-13,778052,CDM,278,RC,C1713,HCPCS,both,,,300,150,,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.2,38.4,,92.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.2,38.4,,92.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,300,70,,240,percent of total billed charges,70% of total billed charges for outpatient setting,300,75,,240,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,35,,84,percent of total billed charges,35% of total billed charges for outpatient setting,234,78,,187.2,percent of total billed charges,78% of total billed charges for outpatient setting,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,210,70,,168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225,75,,180,percent of total billed charges,75% of total billed charges for outpatient setting,249,83,,199.2,percent of total billed charges,83% of total billed charges for outpatient setting,150,50,,120,percent of total billed charges,50% of total billed charges for outpatient setting,150,50,,120,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.5,39.17,,94,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,105,300,
SCREW 2.4X16 MM LOCKING AR 8724VCL-16,778053,CDM,278,RC,C1713,HCPCS,both,,,8038,4019,,5626.6,70,,4501.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3086.59,38.4,,2469.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3086.59,38.4,,2469.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5626.6,70,,4501.28,percent of total billed charges,70% of billed charges for implant carveouts,5626.6,70,,4501.28,percent of total billed charges,70% of billed charges for implant carveouts,5626.6,70,,4501.28,percent of total billed charges,70% of billed charges for implant carveouts,6430.4,80,,5144.32,percent of total billed charges,80% of billed charges for implant carveouts,6430.4,80,,5144.32,percent of total billed charges,80% of billed charges for implant carveouts,5626.6,70,,4501.28,percent of total billed charges,70% of billed charges for implant carveouts,6430.4,80,,5144.32,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2813.3,35,,2250.64,percent of total billed charges,35% of total billed charges for outpatient setting,6269.64,78,,5015.712,percent of total billed charges,78% of total billed charges for outpatient setting,5626.6,70,,4501.28,percent of total billed charges,70% of total billed charges for outpatient setting,5626.6,70,,4501.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6028.5,75,,4822.8,percent of total billed charges,75% of total billed charges for outpatient setting,6671.54,83,,5337.232,percent of total billed charges,83% of total billed charges for outpatient setting,4019,50,,3215.2,percent of total billed charges,50% of total billed charges for outpatient setting,4019,50,,3215.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3148.32,39.17,,2518.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2813.3,6671.54,
SCREW 2.4X18 MM CORTICAL AR 8916CX24-18,778054,CDM,278,RC,C1713,HCPCS,both,,,1285,642.5,,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,449.75,35,,359.8,percent of total billed charges,35% of total billed charges for outpatient setting,1002.3,78,,801.84,percent of total billed charges,78% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,1066.55,83,,853.24,percent of total billed charges,83% of total billed charges for outpatient setting,642.5,50,,514,percent of total billed charges,50% of total billed charges for outpatient setting,642.5,50,,514,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,503.31,39.17,,402.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,449.75,1066.55,
C-ARM / FLUORO,778055,CDM,320,RC,76000,HCPCS,outpatient,,,947,473.5,,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,363.65,38.4,,290.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,363.65,38.4,,290.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.45,35,,265.16,percent of total billed charges,35% of total billed charges for outpatient setting,738.66,78,,590.928,percent of total billed charges,78% of total billed charges for outpatient setting,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,710.25,75,,568.2,percent of total billed charges,75% of total billed charges for outpatient setting,786.01,83,,628.808,percent of total billed charges,83% of total billed charges for outpatient setting,473.5,50,,378.8,percent of total billed charges,50% of total billed charges for outpatient setting,473.5,50,,378.8,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.92,39.17,,296.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,786.01,
SUREFIRE SCORPION AR-1399IN,778056,CDM,270,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
MULTIFIRE SCORPION AR-13995N,778057,CDM,270,RC,,,outpatient,,,824,412,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,316.42,38.4,,253.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,316.42,38.4,,253.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288.4,35,,230.72,percent of total billed charges,35% of total billed charges for outpatient setting,642.72,78,,514.176,percent of total billed charges,78% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,683.92,83,,547.136,percent of total billed charges,83% of total billed charges for outpatient setting,412,50,,329.6,percent of total billed charges,50% of total billed charges for outpatient setting,412,50,,329.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.75,39.17,,258.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,288.4,683.92,
TIGERLINK AR 7535,778058,CDM,270,RC,C1713,HCPCS,outpatient,,,412,206,,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.21,38.4,,126.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.21,38.4,,126.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,309,75,,247.2,percent of total billed charges,75% of total billed charges for outpatient setting,309,75,,247.2,percent of total billed charges,75% of total billed charges for outpatient setting,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,309,75,,247.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.2,35,,115.36,percent of total billed charges,35% of total billed charges for outpatient setting,321.36,78,,257.088,percent of total billed charges,78% of total billed charges for outpatient setting,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,288.4,70,,230.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309,75,,247.2,percent of total billed charges,75% of total billed charges for outpatient setting,341.96,83,,273.568,percent of total billed charges,83% of total billed charges for outpatient setting,206,50,,164.8,percent of total billed charges,50% of total billed charges for outpatient setting,206,50,,164.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.37,39.17,,129.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,144.2,341.96,
FIBERTAPE AR 7237-7,778059,CDM,270,RC,C1713,HCPCS,outpatient,,,241,120.5,,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.54,38.4,,74.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.54,38.4,,74.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.35,35,,67.48,percent of total billed charges,35% of total billed charges for outpatient setting,187.98,78,,150.384,percent of total billed charges,78% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,200.03,83,,160.024,percent of total billed charges,83% of total billed charges for outpatient setting,120.5,50,,96.4,percent of total billed charges,50% of total billed charges for outpatient setting,120.5,50,,96.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.39,39.17,,75.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84.35,200.03,
TIGERTAPE AR 7237-7T,778060,CDM,270,RC,C1713,HCPCS,outpatient,,,242,121,,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.7,35,,67.76,percent of total billed charges,35% of total billed charges for outpatient setting,188.76,78,,151.008,percent of total billed charges,78% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.86,83,,160.688,percent of total billed charges,83% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.79,39.17,,75.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84.7,200.86,
BC KNOTLESS SWL ANCHOR AR-2324KBCC,778061,CDM,278,RC,C1713,HCPCS,both,,,5190,2595,,3633,70,,2906.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1992.96,38.4,,1594.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1992.96,38.4,,1594.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3633,70,,2906.4,percent of total billed charges,70% of billed charges for implant carveouts,3633,70,,2906.4,percent of total billed charges,70% of billed charges for implant carveouts,3633,70,,2906.4,percent of total billed charges,70% of billed charges for implant carveouts,4152,80,,3321.6,percent of total billed charges,80% of billed charges for implant carveouts,4152,80,,3321.6,percent of total billed charges,80% of billed charges for implant carveouts,3633,70,,2906.4,percent of total billed charges,70% of billed charges for implant carveouts,4152,80,,3321.6,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1816.5,35,,1453.2,percent of total billed charges,35% of total billed charges for outpatient setting,4048.2,78,,3238.56,percent of total billed charges,78% of total billed charges for outpatient setting,3633,70,,2906.4,percent of total billed charges,70% of total billed charges for outpatient setting,3633,70,,2906.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3892.5,75,,3114,percent of total billed charges,75% of total billed charges for outpatient setting,4307.7,83,,3446.16,percent of total billed charges,83% of total billed charges for outpatient setting,2595,50,,2076,percent of total billed charges,50% of total billed charges for outpatient setting,2595,50,,2076,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2032.82,39.17,,1626.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1816.5,4307.7,
BC SWL C CLOSED EYELET W/ FIB AR-2323BCC,778062,CDM,278,RC,C1713,HCPCS,both,,,1934,967,,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,742.66,38.4,,594.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,742.66,38.4,,594.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,676.9,35,,541.52,percent of total billed charges,35% of total billed charges for outpatient setting,1508.52,78,,1206.816,percent of total billed charges,78% of total billed charges for outpatient setting,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1450.5,75,,1160.4,percent of total billed charges,75% of total billed charges for outpatient setting,1605.22,83,,1284.176,percent of total billed charges,83% of total billed charges for outpatient setting,967,50,,773.6,percent of total billed charges,50% of total billed charges for outpatient setting,967,50,,773.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,757.51,39.17,,606.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,676.9,1605.22,
BC SUTURE ANCHOR PUSH LOCK  AR-1926BC,778063,CDM,278,RC,C1713,HCPCS,both,,,1934,967,,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,742.66,38.4,,594.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,742.66,38.4,,594.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,1353.8,70,,1083.04,percent of total billed charges,70% of billed charges for implant carveouts,1547.2,80,,1237.76,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,676.9,35,,541.52,percent of total billed charges,35% of total billed charges for outpatient setting,1508.52,78,,1206.816,percent of total billed charges,78% of total billed charges for outpatient setting,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,1353.8,70,,1083.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1450.5,75,,1160.4,percent of total billed charges,75% of total billed charges for outpatient setting,1605.22,83,,1284.176,percent of total billed charges,83% of total billed charges for outpatient setting,967,50,,773.6,percent of total billed charges,50% of total billed charges for outpatient setting,967,50,,773.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,757.51,39.17,,606.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,676.9,1605.22,
IODOSORM PACKING,778064,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
LEG LENGTHENING,778065,CDM,360,RC,,,outpatient,,,5874,2937,,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2255.62,38.4,,1804.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2255.62,38.4,,1804.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2055.9,35,,1644.72,percent of total billed charges,35% of total billed charges for outpatient setting,4581.72,78,,3665.376,percent of total billed charges,78% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,4111.8,70,,3289.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4405.5,75,,3524.4,percent of total billed charges,75% of total billed charges for outpatient setting,4875.42,83,,3900.336,percent of total billed charges,83% of total billed charges for outpatient setting,2937,50,,2349.6,percent of total billed charges,50% of total billed charges for outpatient setting,2937,50,,2349.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2300.73,39.17,,1840.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2055.9,4875.42,
LOOP N TACK 4.75 AR-1665BCSL,778066,CDM,278,RC,C1713,HCPCS,both,,,3870,1935,,2709,70,,2167.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1486.08,38.4,,1188.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1486.08,38.4,,1188.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2709,70,,2167.2,percent of total billed charges,70% of billed charges for implant carveouts,2709,70,,2167.2,percent of total billed charges,70% of billed charges for implant carveouts,2709,70,,2167.2,percent of total billed charges,70% of billed charges for implant carveouts,3096,80,,2476.8,percent of total billed charges,80% of billed charges for implant carveouts,3096,80,,2476.8,percent of total billed charges,80% of billed charges for implant carveouts,2709,70,,2167.2,percent of total billed charges,70% of billed charges for implant carveouts,3096,80,,2476.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1354.5,35,,1083.6,percent of total billed charges,35% of total billed charges for outpatient setting,3018.6,78,,2414.88,percent of total billed charges,78% of total billed charges for outpatient setting,2709,70,,2167.2,percent of total billed charges,70% of total billed charges for outpatient setting,2709,70,,2167.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2902.5,75,,2322,percent of total billed charges,75% of total billed charges for outpatient setting,3212.1,83,,2569.68,percent of total billed charges,83% of total billed charges for outpatient setting,1935,50,,1548,percent of total billed charges,50% of total billed charges for outpatient setting,1935,50,,1548,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.8,39.17,,1212.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1354.5,3212.1,
MASTISOL,778078,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
SEPS,778091,CDM,360,RC,,,outpatient,,,4255,2127.5,,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1633.92,38.4,,1307.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.92,38.4,,1307.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,3191.25,75,,2553,percent of total billed charges,75% of total billed charges for outpatient setting,3191.25,75,,2553,percent of total billed charges,75% of total billed charges for outpatient setting,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,3191.25,75,,2553,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1489.25,35,,1191.4,percent of total billed charges,35% of total billed charges for outpatient setting,3318.9,78,,2655.12,percent of total billed charges,78% of total billed charges for outpatient setting,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,2978.5,70,,2382.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3191.25,75,,2553,percent of total billed charges,75% of total billed charges for outpatient setting,3531.65,83,,2825.32,percent of total billed charges,83% of total billed charges for outpatient setting,2127.5,50,,1702,percent of total billed charges,50% of total billed charges for outpatient setting,2127.5,50,,1702,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1666.6,39.17,,1333.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1489.25,3531.65,
SEPTOPLASTY,778093,CDM,360,RC,,,outpatient,,,1657,828.5,,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,636.29,38.4,,509.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,636.29,38.4,,509.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,1242.75,75,,994.2,percent of total billed charges,75% of total billed charges for outpatient setting,1242.75,75,,994.2,percent of total billed charges,75% of total billed charges for outpatient setting,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,1242.75,75,,994.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,579.95,35,,463.96,percent of total billed charges,35% of total billed charges for outpatient setting,1292.46,78,,1033.968,percent of total billed charges,78% of total billed charges for outpatient setting,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,1159.9,70,,927.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1242.75,75,,994.2,percent of total billed charges,75% of total billed charges for outpatient setting,1375.31,83,,1100.248,percent of total billed charges,83% of total billed charges for outpatient setting,828.5,50,,662.8,percent of total billed charges,50% of total billed charges for outpatient setting,828.5,50,,662.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,649.02,39.17,,519.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,579.95,1375.31,
HAND ASSISTED CASE,778095,CDM,360,RC,,,outpatient,,,5263,2631.5,,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2020.99,38.4,,1616.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2020.99,38.4,,1616.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,3947.25,75,,3157.8,percent of total billed charges,75% of total billed charges for outpatient setting,3947.25,75,,3157.8,percent of total billed charges,75% of total billed charges for outpatient setting,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,3947.25,75,,3157.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1842.05,35,,1473.64,percent of total billed charges,35% of total billed charges for outpatient setting,4105.14,78,,3284.112,percent of total billed charges,78% of total billed charges for outpatient setting,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,3684.1,70,,2947.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3947.25,75,,3157.8,percent of total billed charges,75% of total billed charges for outpatient setting,4368.29,83,,3494.632,percent of total billed charges,83% of total billed charges for outpatient setting,2631.5,50,,2105.2,percent of total billed charges,50% of total billed charges for outpatient setting,2631.5,50,,2105.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2061.41,39.17,,1649.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1842.05,4368.29,
FINGER TRIGGER,778098,CDM,270,RC,,,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
MINOR ORTHO CHARGE,778101,CDM,360,RC,,,outpatient,,,808,404,,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,310.27,38.4,,248.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,310.27,38.4,,248.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.8,35,,226.24,percent of total billed charges,35% of total billed charges for outpatient setting,630.24,78,,504.192,percent of total billed charges,78% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,670.64,83,,536.512,percent of total billed charges,83% of total billed charges for outpatient setting,404,50,,323.2,percent of total billed charges,50% of total billed charges for outpatient setting,404,50,,323.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,316.48,39.17,,253.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,282.8,670.64,
FEMORAL HEAD,778104,CDM,360,RC,,,outpatient,,,2509,1254.5,,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,963.46,38.4,,770.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,963.46,38.4,,770.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,1881.75,75,,1505.4,percent of total billed charges,75% of total billed charges for outpatient setting,1881.75,75,,1505.4,percent of total billed charges,75% of total billed charges for outpatient setting,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,1881.75,75,,1505.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,878.15,35,,702.52,percent of total billed charges,35% of total billed charges for outpatient setting,1957.02,78,,1565.616,percent of total billed charges,78% of total billed charges for outpatient setting,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,1756.3,70,,1405.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1881.75,75,,1505.4,percent of total billed charges,75% of total billed charges for outpatient setting,2082.47,83,,1665.976,percent of total billed charges,83% of total billed charges for outpatient setting,1254.5,50,,1003.6,percent of total billed charges,50% of total billed charges for outpatient setting,1254.5,50,,1003.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,982.73,39.17,,786.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,878.15,2082.47,
BRONCHOSCOPY/OR,778114,CDM,360,RC,,,outpatient,,,2211,1105.5,,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,849.02,38.4,,679.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,849.02,38.4,,679.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,1658.25,75,,1326.6,percent of total billed charges,75% of total billed charges for outpatient setting,1658.25,75,,1326.6,percent of total billed charges,75% of total billed charges for outpatient setting,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,1658.25,75,,1326.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,773.85,35,,619.08,percent of total billed charges,35% of total billed charges for outpatient setting,1724.58,78,,1379.664,percent of total billed charges,78% of total billed charges for outpatient setting,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,1547.7,70,,1238.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1658.25,75,,1326.6,percent of total billed charges,75% of total billed charges for outpatient setting,1835.13,83,,1468.104,percent of total billed charges,83% of total billed charges for outpatient setting,1105.5,50,,884.4,percent of total billed charges,50% of total billed charges for outpatient setting,1105.5,50,,884.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,866,39.17,,692.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,773.85,1835.13,
SENTIME/AX. NODE DISSECTION,778118,CDM,360,RC,,,outpatient,,,2960,1480,,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1136.64,38.4,,909.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1136.64,38.4,,909.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,2220,75,,1776,percent of total billed charges,75% of total billed charges for outpatient setting,2220,75,,1776,percent of total billed charges,75% of total billed charges for outpatient setting,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,2220,75,,1776,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1036,35,,828.8,percent of total billed charges,35% of total billed charges for outpatient setting,2308.8,78,,1847.04,percent of total billed charges,78% of total billed charges for outpatient setting,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,2072,70,,1657.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2220,75,,1776,percent of total billed charges,75% of total billed charges for outpatient setting,2456.8,83,,1965.44,percent of total billed charges,83% of total billed charges for outpatient setting,1480,50,,1184,percent of total billed charges,50% of total billed charges for outpatient setting,1480,50,,1184,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1159.37,39.17,,927.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1036,2456.8,
SPOT ENDOSCOPIC MARKER,778119,CDM,270,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
I-D ABSCESS THIGH KNEE,778120,CDM,360,RC,27301,HCPCS,outpatient,,,3231,1615.5,,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1240.7,38.4,,992.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1240.7,38.4,,992.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2423.25,75,,1938.6,percent of total billed charges,75% of total billed charges for outpatient setting,2423.25,75,,1938.6,percent of total billed charges,75% of total billed charges for outpatient setting,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2423.25,75,,1938.6,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1130.85,35,,904.68,percent of total billed charges,35% of total billed charges for outpatient setting,2520.18,78,,2016.144,percent of total billed charges,78% of total billed charges for outpatient setting,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2261.7,70,,1809.36,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2423.25,75,,1938.6,percent of total billed charges,75% of total billed charges for outpatient setting,2681.73,83,,2145.384,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1265.51,39.17,,1012.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1130.85,3141,
CLOSED FX FIBULA @ MANIPULATIO,778121,CDM,360,RC,27781,HCPCS,outpatient,,,987,493.5,,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,379.01,38.4,,303.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,379.01,38.4,,303.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,740.25,75,,592.2,percent of total billed charges,75% of total billed charges for outpatient setting,740.25,75,,592.2,percent of total billed charges,75% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,740.25,75,,592.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.45,35,,276.36,percent of total billed charges,35% of total billed charges for outpatient setting,769.86,78,,615.888,percent of total billed charges,78% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,740.25,75,,592.2,percent of total billed charges,75% of total billed charges for outpatient setting,819.21,83,,655.368,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.59,39.17,,309.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.45,1452,
EGD/COLONOSCOPY (E),778122,CDM,750,RC,,,outpatient,,,1253,626.5,,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,481.15,38.4,,384.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,481.15,38.4,,384.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,939.75,75,,751.8,percent of total billed charges,75% of total billed charges for outpatient setting,939.75,75,,751.8,percent of total billed charges,75% of total billed charges for outpatient setting,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,939.75,75,,751.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438.55,35,,350.84,percent of total billed charges,35% of total billed charges for outpatient setting,977.34,78,,781.872,percent of total billed charges,78% of total billed charges for outpatient setting,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,877.1,70,,701.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,939.75,75,,751.8,percent of total billed charges,75% of total billed charges for outpatient setting,1039.99,83,,831.992,percent of total billed charges,83% of total billed charges for outpatient setting,626.5,50,,501.2,percent of total billed charges,50% of total billed charges for outpatient setting,626.5,50,,501.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,490.77,39.17,,392.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,438.55,1039.99,
DIAGNOSTIC LAP HYSTERSCOPE/DNC,778124,CDM,360,RC,,,outpatient,,,4607,2303.5,,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1769.09,38.4,,1415.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1769.09,38.4,,1415.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,3455.25,75,,2764.2,percent of total billed charges,75% of total billed charges for outpatient setting,3455.25,75,,2764.2,percent of total billed charges,75% of total billed charges for outpatient setting,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,3455.25,75,,2764.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1612.45,35,,1289.96,percent of total billed charges,35% of total billed charges for outpatient setting,3593.46,78,,2874.768,percent of total billed charges,78% of total billed charges for outpatient setting,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,3224.9,70,,2579.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3455.25,75,,2764.2,percent of total billed charges,75% of total billed charges for outpatient setting,3823.81,83,,3059.048,percent of total billed charges,83% of total billed charges for outpatient setting,2303.5,50,,1842.8,percent of total billed charges,50% of total billed charges for outpatient setting,2303.5,50,,1842.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1804.47,39.17,,1443.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1612.45,3823.81,
HYSTERSCOPE/DNC,778125,CDM,360,RC,,,outpatient,,,1895,947.5,,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,727.68,38.4,,582.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,727.68,38.4,,582.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.25,35,,530.6,percent of total billed charges,35% of total billed charges for outpatient setting,1478.1,78,,1182.48,percent of total billed charges,78% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1572.85,83,,1258.28,percent of total billed charges,83% of total billed charges for outpatient setting,947.5,50,,758,percent of total billed charges,50% of total billed charges for outpatient setting,947.5,50,,758,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,742.23,39.17,,593.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,663.25,1572.85,
TOTAL VAGINAL COLPOCLIESIS,778126,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
TOTAL SHOULDER REPLACEMENT,778127,CDM,360,RC,,,outpatient,,,4088,2044,,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1569.79,38.4,,1255.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1569.79,38.4,,1255.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1430.8,35,,1144.64,percent of total billed charges,35% of total billed charges for outpatient setting,3188.64,78,,2550.912,percent of total billed charges,78% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,3393.04,83,,2714.432,percent of total billed charges,83% of total billed charges for outpatient setting,2044,50,,1635.2,percent of total billed charges,50% of total billed charges for outpatient setting,2044,50,,1635.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1601.19,39.17,,1280.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1430.8,3393.04,
TVT BLADDER SUSPENSION,778128,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
TONSILLECTOMY @ COBLATION,778130,CDM,360,RC,,,outpatient,,,1544,772,,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.4,35,,432.32,percent of total billed charges,35% of total billed charges for outpatient setting,1204.32,78,,963.456,percent of total billed charges,78% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1281.52,83,,1025.216,percent of total billed charges,83% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,604.76,39.17,,483.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,540.4,1281.52,
EXCISION HEEL ULCER & OSTEOECT,778132,CDM,360,RC,,,outpatient,,,1521,760.5,,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,584.06,38.4,,467.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.06,38.4,,467.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,1140.75,75,,912.6,percent of total billed charges,75% of total billed charges for outpatient setting,1140.75,75,,912.6,percent of total billed charges,75% of total billed charges for outpatient setting,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,1140.75,75,,912.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,532.35,35,,425.88,percent of total billed charges,35% of total billed charges for outpatient setting,1186.38,78,,949.104,percent of total billed charges,78% of total billed charges for outpatient setting,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,1064.7,70,,851.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1140.75,75,,912.6,percent of total billed charges,75% of total billed charges for outpatient setting,1262.43,83,,1009.944,percent of total billed charges,83% of total billed charges for outpatient setting,760.5,50,,608.4,percent of total billed charges,50% of total billed charges for outpatient setting,760.5,50,,608.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,595.74,39.17,,476.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,532.35,1262.43,
TEMPORAL ARTERY BIOPSY,778133,CDM,360,RC,,,outpatient,,,596,298,,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.86,38.4,,183.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.86,38.4,,183.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,447,75,,357.6,percent of total billed charges,75% of total billed charges for outpatient setting,447,75,,357.6,percent of total billed charges,75% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,447,75,,357.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,208.6,35,,166.88,percent of total billed charges,35% of total billed charges for outpatient setting,464.88,78,,371.904,percent of total billed charges,78% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447,75,,357.6,percent of total billed charges,75% of total billed charges for outpatient setting,494.68,83,,395.744,percent of total billed charges,83% of total billed charges for outpatient setting,298,50,,238.4,percent of total billed charges,50% of total billed charges for outpatient setting,298,50,,238.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,233.44,39.17,,186.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,208.6,494.68,
TVT DEVICE,778134,CDM,274,RC,,,both,,,1074,537,,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,751.8,70,,601.44,percent of total billed charges,70% of billed charges for implant carveouts,751.8,70,,601.44,percent of total billed charges,70% of billed charges for implant carveouts,751.8,70,,601.44,percent of total billed charges,70% of billed charges for implant carveouts,859.2,80,,687.36,percent of total billed charges,80% of billed charges for implant carveouts,859.2,80,,687.36,percent of total billed charges,80% of billed charges for implant carveouts,751.8,70,,601.44,percent of total billed charges,70% of billed charges for implant carveouts,859.2,80,,687.36,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.9,35,,300.72,percent of total billed charges,35% of total billed charges for outpatient setting,837.72,78,,670.176,percent of total billed charges,78% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.42,83,,713.136,percent of total billed charges,83% of total billed charges for outpatient setting,537,50,,429.6,percent of total billed charges,50% of total billed charges for outpatient setting,537,50,,429.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,420.67,39.17,,336.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,375.9,891.42,
BILATERAL BUNIONECTOMY,778135,CDM,360,RC,,,outpatient,,,2213,1106.5,,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,849.79,38.4,,679.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,849.79,38.4,,679.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,1659.75,75,,1327.8,percent of total billed charges,75% of total billed charges for outpatient setting,1659.75,75,,1327.8,percent of total billed charges,75% of total billed charges for outpatient setting,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,1659.75,75,,1327.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,774.55,35,,619.64,percent of total billed charges,35% of total billed charges for outpatient setting,1726.14,78,,1380.912,percent of total billed charges,78% of total billed charges for outpatient setting,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,1549.1,70,,1239.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1659.75,75,,1327.8,percent of total billed charges,75% of total billed charges for outpatient setting,1836.79,83,,1469.432,percent of total billed charges,83% of total billed charges for outpatient setting,1106.5,50,,885.2,percent of total billed charges,50% of total billed charges for outpatient setting,1106.5,50,,885.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,866.79,39.17,,693.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,774.55,1836.79,
BILATERAL BUNIONECTOMY W/HAMME,778137,CDM,360,RC,,,outpatient,,,2264,1132,,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.4,35,,633.92,percent of total billed charges,35% of total billed charges for outpatient setting,1765.92,78,,1412.736,percent of total billed charges,78% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1879.12,83,,1503.296,percent of total billed charges,83% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,886.77,39.17,,709.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,792.4,1879.12,
LAP CHOLE CONVERTED OPEN PROCE,778139,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
LONG LEG CAST APPLICATION W/SE,778140,CDM,360,RC,,,outpatient,,,644,322,,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.4,35,,180.32,percent of total billed charges,35% of total billed charges for outpatient setting,502.32,78,,401.856,percent of total billed charges,78% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.52,83,,427.616,percent of total billed charges,83% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.25,39.17,,201.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.4,534.52,
HEEL SPUR EXCISION,778141,CDM,360,RC,,,outpatient,,,736,368,,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.62,38.4,,226.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,282.62,38.4,,226.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,257.6,35,,206.08,percent of total billed charges,35% of total billed charges for outpatient setting,574.08,78,,459.264,percent of total billed charges,78% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,515.2,70,,412.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,552,75,,441.6,percent of total billed charges,75% of total billed charges for outpatient setting,610.88,83,,488.704,percent of total billed charges,83% of total billed charges for outpatient setting,368,50,,294.4,percent of total billed charges,50% of total billed charges for outpatient setting,368,50,,294.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288.27,39.17,,230.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,257.6,610.88,
REMOVAL OF RETAINED SCREW,778142,CDM,360,RC,,,outpatient,,,464,232,,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.18,38.4,,142.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.18,38.4,,142.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.4,35,,129.92,percent of total billed charges,35% of total billed charges for outpatient setting,361.92,78,,289.536,percent of total billed charges,78% of total billed charges for outpatient setting,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,324.8,70,,259.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,385.12,83,,308.096,percent of total billed charges,83% of total billed charges for outpatient setting,232,50,,185.6,percent of total billed charges,50% of total billed charges for outpatient setting,232,50,,185.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.74,39.17,,145.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,162.4,385.12,
"MYOMECTOMY, EXP LAP",778144,CDM,360,RC,,,outpatient,,,3994,1997,,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1397.9,35,,1118.32,percent of total billed charges,35% of total billed charges for outpatient setting,3115.32,78,,2492.256,percent of total billed charges,78% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,3315.02,83,,2652.016,percent of total billed charges,83% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1564.37,39.17,,1251.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1397.9,3315.02,
HAMMERTOE CORRECTION,778145,CDM,360,RC,,,outpatient,,,2074,1037,,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,796.42,38.4,,637.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,796.42,38.4,,637.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,1555.5,75,,1244.4,percent of total billed charges,75% of total billed charges for outpatient setting,1555.5,75,,1244.4,percent of total billed charges,75% of total billed charges for outpatient setting,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,1555.5,75,,1244.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,725.9,35,,580.72,percent of total billed charges,35% of total billed charges for outpatient setting,1617.72,78,,1294.176,percent of total billed charges,78% of total billed charges for outpatient setting,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,1451.8,70,,1161.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1555.5,75,,1244.4,percent of total billed charges,75% of total billed charges for outpatient setting,1721.42,83,,1377.136,percent of total billed charges,83% of total billed charges for outpatient setting,1037,50,,829.6,percent of total billed charges,50% of total billed charges for outpatient setting,1037,50,,829.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,812.35,39.17,,649.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,725.9,1721.42,
"CLOSURE OF SACRAL DECUBITUS, C",778146,CDM,360,RC,,,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,448.7,1064.06,
ANTERIOR/POSTERIOR REPAIR W/SS,778147,CDM,360,RC,,,outpatient,,,2085,1042.5,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,729.75,35,,583.8,percent of total billed charges,35% of total billed charges for outpatient setting,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1730.55,83,,1384.44,percent of total billed charges,83% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.65,39.17,,653.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,729.75,1730.55,
ANKLE ARTHROSCOPY,778148,CDM,360,RC,,,outpatient,,,2138,1069,,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.3,35,,598.64,percent of total billed charges,35% of total billed charges for outpatient setting,1667.64,78,,1334.112,percent of total billed charges,78% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1774.54,83,,1419.632,percent of total billed charges,83% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,837.41,39.17,,669.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,748.3,1774.54,
DEBRIDEMENT OF ULCERS W/SKIN G,778149,CDM,360,RC,,,outpatient,,,1436,718,,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,551.42,38.4,,441.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,551.42,38.4,,441.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.6,35,,402.08,percent of total billed charges,35% of total billed charges for outpatient setting,1120.08,78,,896.064,percent of total billed charges,78% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1191.88,83,,953.504,percent of total billed charges,83% of total billed charges for outpatient setting,718,50,,574.4,percent of total billed charges,50% of total billed charges for outpatient setting,718,50,,574.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.45,39.17,,449.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,502.6,1191.88,
REMOVAL EXOSTOSIS FOOT,778150,CDM,360,RC,,,outpatient,,,1615,807.5,,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,620.16,38.4,,496.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,620.16,38.4,,496.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,1211.25,75,,969,percent of total billed charges,75% of total billed charges for outpatient setting,1211.25,75,,969,percent of total billed charges,75% of total billed charges for outpatient setting,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,1211.25,75,,969,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,565.25,35,,452.2,percent of total billed charges,35% of total billed charges for outpatient setting,1259.7,78,,1007.76,percent of total billed charges,78% of total billed charges for outpatient setting,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,1130.5,70,,904.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1211.25,75,,969,percent of total billed charges,75% of total billed charges for outpatient setting,1340.45,83,,1072.36,percent of total billed charges,83% of total billed charges for outpatient setting,807.5,50,,646,percent of total billed charges,50% of total billed charges for outpatient setting,807.5,50,,646,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,632.56,39.17,,506.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,565.25,1340.45,
REPAIR COMPLEX FACIAL LACERATI,778151,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
NERVE REPAIR - DIGIT,778152,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
EGD/FLEX,778154,CDM,360,RC,,,outpatient,,,1718,859,,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,659.71,38.4,,527.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,659.71,38.4,,527.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,1288.5,75,,1030.8,percent of total billed charges,75% of total billed charges for outpatient setting,1288.5,75,,1030.8,percent of total billed charges,75% of total billed charges for outpatient setting,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,1288.5,75,,1030.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,601.3,35,,481.04,percent of total billed charges,35% of total billed charges for outpatient setting,1340.04,78,,1072.032,percent of total billed charges,78% of total billed charges for outpatient setting,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,1202.6,70,,962.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1288.5,75,,1030.8,percent of total billed charges,75% of total billed charges for outpatient setting,1425.94,83,,1140.752,percent of total billed charges,83% of total billed charges for outpatient setting,859,50,,687.2,percent of total billed charges,50% of total billed charges for outpatient setting,859,50,,687.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.9,39.17,,538.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,601.3,1425.94,
EGD IN OR,778155,CDM,360,RC,,,outpatient,,,1372,686,,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,526.85,38.4,,421.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,526.85,38.4,,421.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,1029,75,,823.2,percent of total billed charges,75% of total billed charges for outpatient setting,1029,75,,823.2,percent of total billed charges,75% of total billed charges for outpatient setting,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,1029,75,,823.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,480.2,35,,384.16,percent of total billed charges,35% of total billed charges for outpatient setting,1070.16,78,,856.128,percent of total billed charges,78% of total billed charges for outpatient setting,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,960.4,70,,768.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1029,75,,823.2,percent of total billed charges,75% of total billed charges for outpatient setting,1138.76,83,,911.008,percent of total billed charges,83% of total billed charges for outpatient setting,686,50,,548.8,percent of total billed charges,50% of total billed charges for outpatient setting,686,50,,548.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,537.39,39.17,,429.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,480.2,1138.76,
EXCISION SKIN LESION,778156,CDM,360,RC,,,outpatient,,,1400,700,,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,537.6,38.4,,430.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,537.6,38.4,,430.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,1050,75,,840,percent of total billed charges,75% of total billed charges for outpatient setting,1050,75,,840,percent of total billed charges,75% of total billed charges for outpatient setting,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,1050,75,,840,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,490,35,,392,percent of total billed charges,35% of total billed charges for outpatient setting,1092,78,,873.6,percent of total billed charges,78% of total billed charges for outpatient setting,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,980,70,,784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1050,75,,840,percent of total billed charges,75% of total billed charges for outpatient setting,1162,83,,929.6,percent of total billed charges,83% of total billed charges for outpatient setting,700,50,,560,percent of total billed charges,50% of total billed charges for outpatient setting,700,50,,560,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,548.35,39.17,,438.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,490,1162,
REPAIR LACERATION - FINGER,778157,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
TONGUE LACERATION,778158,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
LUMPECTOMY,778159,CDM,360,RC,,,outpatient,,,2333,1166.5,,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.55,35,,653.24,percent of total billed charges,35% of total billed charges for outpatient setting,1819.74,78,,1455.792,percent of total billed charges,78% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1936.39,83,,1549.112,percent of total billed charges,83% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.79,39.17,,731.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.55,1936.39,
EXCISION BASAL CA FACE W/COMPL,778160,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
ENDO BADCOCK DISPOSIBLE,778161,CDM,270,RC,,,outpatient,,,215,107.5,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.25,35,,60.2,percent of total billed charges,35% of total billed charges for outpatient setting,167.7,78,,134.16,percent of total billed charges,78% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,178.45,83,,142.76,percent of total billed charges,83% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.21,39.17,,67.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,75.25,178.45,
EXP LAP REPAIR OF PARAESOPHAGE,778162,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
TRANSPOSITION OF NERVE,778163,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
TRANSURETHRAL CONTIGEN PROCEDU,778166,CDM,360,RC,,,outpatient,,,1544,772,,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.4,35,,432.32,percent of total billed charges,35% of total billed charges for outpatient setting,1204.32,78,,963.456,percent of total billed charges,78% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1281.52,83,,1025.216,percent of total billed charges,83% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,604.76,39.17,,483.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,540.4,1281.52,
HERNIA TACKER,778168,CDM,270,RC,,,outpatient,,,735,367.5,,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.24,38.4,,225.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,282.24,38.4,,225.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,551.25,75,,441,percent of total billed charges,75% of total billed charges for outpatient setting,551.25,75,,441,percent of total billed charges,75% of total billed charges for outpatient setting,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,551.25,75,,441,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,257.25,35,,205.8,percent of total billed charges,35% of total billed charges for outpatient setting,573.3,78,,458.64,percent of total billed charges,78% of total billed charges for outpatient setting,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,514.5,70,,411.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,551.25,75,,441,percent of total billed charges,75% of total billed charges for outpatient setting,610.05,83,,488.04,percent of total billed charges,83% of total billed charges for outpatient setting,367.5,50,,294,percent of total billed charges,50% of total billed charges for outpatient setting,367.5,50,,294,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,287.88,39.17,,230.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,257.25,610.05,
TLC PLACEMENT WITH SEDATION,778169,CDM,360,RC,,,outpatient,,,232,116,,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.2,35,,64.96,percent of total billed charges,35% of total billed charges for outpatient setting,180.96,78,,144.768,percent of total billed charges,78% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.56,83,,154.048,percent of total billed charges,83% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.87,39.17,,72.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.2,192.56,
REMOVAL OF K WIRE,778170,CDM,360,RC,,,outpatient,,,916,458,,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,351.74,38.4,,281.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,351.74,38.4,,281.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,687,75,,549.6,percent of total billed charges,75% of total billed charges for outpatient setting,687,75,,549.6,percent of total billed charges,75% of total billed charges for outpatient setting,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,687,75,,549.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,320.6,35,,256.48,percent of total billed charges,35% of total billed charges for outpatient setting,714.48,78,,571.584,percent of total billed charges,78% of total billed charges for outpatient setting,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,641.2,70,,512.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,687,75,,549.6,percent of total billed charges,75% of total billed charges for outpatient setting,760.28,83,,608.224,percent of total billed charges,83% of total billed charges for outpatient setting,458,50,,366.4,percent of total billed charges,50% of total billed charges for outpatient setting,458,50,,366.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,358.77,39.17,,287.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,320.6,760.28,
LAP CHOLE/OPERATIVE LAP GYN,778171,CDM,360,RC,,,outpatient,,,6490,3245,,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2492.16,38.4,,1993.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2492.16,38.4,,1993.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,4867.5,75,,3894,percent of total billed charges,75% of total billed charges for outpatient setting,4867.5,75,,3894,percent of total billed charges,75% of total billed charges for outpatient setting,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,4867.5,75,,3894,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2271.5,35,,1817.2,percent of total billed charges,35% of total billed charges for outpatient setting,5062.2,78,,4049.76,percent of total billed charges,78% of total billed charges for outpatient setting,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,4543,70,,3634.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4867.5,75,,3894,percent of total billed charges,75% of total billed charges for outpatient setting,5386.7,83,,4309.36,percent of total billed charges,83% of total billed charges for outpatient setting,3245,50,,2596,percent of total billed charges,50% of total billed charges for outpatient setting,3245,50,,2596,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2542,39.17,,2033.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2271.5,5386.7,
"SEPTOPLASTY, SMR OF TURBINATE",778172,CDM,360,RC,,,outpatient,,,2161,1080.5,,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,829.82,38.4,,663.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,829.82,38.4,,663.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,1620.75,75,,1296.6,percent of total billed charges,75% of total billed charges for outpatient setting,1620.75,75,,1296.6,percent of total billed charges,75% of total billed charges for outpatient setting,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,1620.75,75,,1296.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,756.35,35,,605.08,percent of total billed charges,35% of total billed charges for outpatient setting,1685.58,78,,1348.464,percent of total billed charges,78% of total billed charges for outpatient setting,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,1512.7,70,,1210.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1620.75,75,,1296.6,percent of total billed charges,75% of total billed charges for outpatient setting,1793.63,83,,1434.904,percent of total billed charges,83% of total billed charges for outpatient setting,1080.5,50,,864.4,percent of total billed charges,50% of total billed charges for outpatient setting,1080.5,50,,864.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,846.42,39.17,,677.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,756.35,1793.63,
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK,778173,CDM,360,RC,,,outpatient,,,3360,1680,,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1290.24,38.4,,1032.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1290.24,38.4,,1032.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,2520,75,,2016,percent of total billed charges,75% of total billed charges for outpatient setting,2520,75,,2016,percent of total billed charges,75% of total billed charges for outpatient setting,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,2520,75,,2016,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1176,35,,940.8,percent of total billed charges,35% of total billed charges for outpatient setting,2620.8,78,,2096.64,percent of total billed charges,78% of total billed charges for outpatient setting,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,2352,70,,1881.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2520,75,,2016,percent of total billed charges,75% of total billed charges for outpatient setting,2788.8,83,,2231.04,percent of total billed charges,83% of total billed charges for outpatient setting,1680,50,,1344,percent of total billed charges,50% of total billed charges for outpatient setting,1680,50,,1344,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1316.04,39.17,,1052.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1176,2788.8,
SUPRACLAVICULAR BLOCK,778174,CDM,360,RC,,,outpatient,,,1485,742.5,,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,570.24,38.4,,456.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,570.24,38.4,,456.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,1113.75,75,,891,percent of total billed charges,75% of total billed charges for outpatient setting,1113.75,75,,891,percent of total billed charges,75% of total billed charges for outpatient setting,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,1113.75,75,,891,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,519.75,35,,415.8,percent of total billed charges,35% of total billed charges for outpatient setting,1158.3,78,,926.64,percent of total billed charges,78% of total billed charges for outpatient setting,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,1039.5,70,,831.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1113.75,75,,891,percent of total billed charges,75% of total billed charges for outpatient setting,1232.55,83,,986.04,percent of total billed charges,83% of total billed charges for outpatient setting,742.5,50,,594,percent of total billed charges,50% of total billed charges for outpatient setting,742.5,50,,594,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,581.64,39.17,,465.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,519.75,1232.55,
GENICULAR NERVE BRANCHES BLOCK,778175,CDM,360,RC,,,outpatient,,,635,317.5,,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,243.84,38.4,,195.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,243.84,38.4,,195.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,476.25,75,,381,percent of total billed charges,75% of total billed charges for outpatient setting,476.25,75,,381,percent of total billed charges,75% of total billed charges for outpatient setting,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,476.25,75,,381,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,222.25,35,,177.8,percent of total billed charges,35% of total billed charges for outpatient setting,495.3,78,,396.24,percent of total billed charges,78% of total billed charges for outpatient setting,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,444.5,70,,355.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,476.25,75,,381,percent of total billed charges,75% of total billed charges for outpatient setting,527.05,83,,421.64,percent of total billed charges,83% of total billed charges for outpatient setting,317.5,50,,254,percent of total billed charges,50% of total billed charges for outpatient setting,317.5,50,,254,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,248.72,39.17,,198.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,222.25,527.05,
PLATE -  5 HOLE LATERAL FIBULA,778176,CDM,278,RC,C1713,HCPCS,both,,,3420,1710,,2394,70,,1915.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1313.28,38.4,,1050.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1313.28,38.4,,1050.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2394,70,,1915.2,percent of total billed charges,70% of billed charges for implant carveouts,2394,70,,1915.2,percent of total billed charges,70% of billed charges for implant carveouts,2394,70,,1915.2,percent of total billed charges,70% of billed charges for implant carveouts,2736,80,,2188.8,percent of total billed charges,80% of billed charges for implant carveouts,2736,80,,2188.8,percent of total billed charges,80% of billed charges for implant carveouts,2394,70,,1915.2,percent of total billed charges,70% of billed charges for implant carveouts,2736,80,,2188.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1197,35,,957.6,percent of total billed charges,35% of total billed charges for outpatient setting,2667.6,78,,2134.08,percent of total billed charges,78% of total billed charges for outpatient setting,2394,70,,1915.2,percent of total billed charges,70% of total billed charges for outpatient setting,2394,70,,1915.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2565,75,,2052,percent of total billed charges,75% of total billed charges for outpatient setting,2838.6,83,,2270.88,percent of total billed charges,83% of total billed charges for outpatient setting,1710,50,,1368,percent of total billed charges,50% of total billed charges for outpatient setting,1710,50,,1368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1339.55,39.17,,1071.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1197,2838.6,
SCREW 3.5X16 MM NON LOCKING 30-0259,778177,CDM,278,RC,C1713,HCPCS,both,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.1,246,
SCREW 2.7X14 MM LOCKING 30-0327,778178,CDM,278,RC,C1713,HCPCS,both,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW 2.7X12 MM LOCKING 30-0326,778179,CDM,278,RC,C1713,HCPCS,both,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,672,70,,537.6,percent of total billed charges,70% of billed charges for implant carveouts,768,80,,614.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW 2.7X10 MM LOCKING 30-0325,778180,CDM,278,RC,C1713,HCPCS,both,,,411,205.5,,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,38.4,,126.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.82,38.4,,126.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,411,70,,328.8,percent of total billed charges,70% of total billed charges for outpatient setting,411,70,,328.8,percent of total billed charges,70% of total billed charges for outpatient setting,411,70,,328.8,percent of total billed charges,70% of total billed charges for outpatient setting,411,75,,328.8,percent of total billed charges,75% of total billed charges for outpatient setting,411,75,,328.8,percent of total billed charges,75% of total billed charges for outpatient setting,411,70,,328.8,percent of total billed charges,70% of total billed charges for outpatient setting,411,75,,328.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.85,35,,115.08,percent of total billed charges,35% of total billed charges for outpatient setting,320.58,78,,256.464,percent of total billed charges,78% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,308.25,75,,246.6,percent of total billed charges,75% of total billed charges for outpatient setting,341.13,83,,272.904,percent of total billed charges,83% of total billed charges for outpatient setting,205.5,50,,164.4,percent of total billed charges,50% of total billed charges for outpatient setting,205.5,50,,164.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.98,39.17,,128.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,143.85,411,
SCREW 3.5X14 MM LOCKING 30-0235,778181,CDM,278,RC,C1713,HCPCS,both,,,700,350,,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,490,70,,392,percent of total billed charges,70% of billed charges for implant carveouts,490,70,,392,percent of total billed charges,70% of billed charges for implant carveouts,490,70,,392,percent of total billed charges,70% of billed charges for implant carveouts,560,80,,448,percent of total billed charges,80% of billed charges for implant carveouts,560,80,,448,percent of total billed charges,80% of billed charges for implant carveouts,490,70,,392,percent of total billed charges,70% of billed charges for implant carveouts,560,80,,448,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245,35,,196,percent of total billed charges,35% of total billed charges for outpatient setting,546,78,,436.8,percent of total billed charges,78% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,581,83,,464.8,percent of total billed charges,83% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.18,39.17,,219.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,245,581,
DRILL BIT 2.0 80-2378,778182,CDM,278,RC,C1713,HCPCS,both,,,1160,580,,812,70,,649.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,445.44,38.4,,356.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445.44,38.4,,356.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,812,70,,649.6,percent of total billed charges,70% of billed charges for implant carveouts,812,70,,649.6,percent of total billed charges,70% of billed charges for implant carveouts,812,70,,649.6,percent of total billed charges,70% of billed charges for implant carveouts,928,80,,742.4,percent of total billed charges,80% of billed charges for implant carveouts,928,80,,742.4,percent of total billed charges,80% of billed charges for implant carveouts,812,70,,649.6,percent of total billed charges,70% of billed charges for implant carveouts,928,80,,742.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,406,35,,324.8,percent of total billed charges,35% of total billed charges for outpatient setting,904.8,78,,723.84,percent of total billed charges,78% of total billed charges for outpatient setting,812,70,,649.6,percent of total billed charges,70% of total billed charges for outpatient setting,812,70,,649.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,870,75,,696,percent of total billed charges,75% of total billed charges for outpatient setting,962.8,83,,770.24,percent of total billed charges,83% of total billed charges for outpatient setting,580,50,,464,percent of total billed charges,50% of total billed charges for outpatient setting,580,50,,464,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.35,39.17,,363.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,406,962.8,
DRILL BIT 2.8 80-2379,778183,CDM,278,RC,C1713,HCPCS,both,,,1165,582.5,,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,815.5,70,,652.4,percent of total billed charges,70% of billed charges for implant carveouts,815.5,70,,652.4,percent of total billed charges,70% of billed charges for implant carveouts,815.5,70,,652.4,percent of total billed charges,70% of billed charges for implant carveouts,932,80,,745.6,percent of total billed charges,80% of billed charges for implant carveouts,932,80,,745.6,percent of total billed charges,80% of billed charges for implant carveouts,815.5,70,,652.4,percent of total billed charges,70% of billed charges for implant carveouts,932,80,,745.6,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,407.75,35,,326.2,percent of total billed charges,35% of total billed charges for outpatient setting,908.7,78,,726.96,percent of total billed charges,78% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,966.95,83,,773.56,percent of total billed charges,83% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.31,39.17,,365.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,407.75,966.95,
DRILL BIT 2.9 AR 8741-25,778184,CDM,278,RC,C1713,HCPCS,both,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,35,,273,percent of total billed charges,35% of total billed charges for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.89,39.17,,305.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,341.25,809.25,
DRILL BIT 2.2 AR 8737-34,778185,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
K WIRE 2.5 AR 8737-39,778186,CDM,278,RC,C1713,HCPCS,both,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111,70,,88.8,percent of total billed charges,70% of total billed charges for outpatient setting,111,70,,88.8,percent of total billed charges,70% of total billed charges for outpatient setting,111,70,,88.8,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,70,,88.8,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.85,111,
PROFILE DRILL 2.5 AR 8737-46,778187,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
SCREW BEVELED FT 3.5X46MM AR-8736BV-46,778188,CDM,278,RC,C1713,HCPCS,both,,,3975,1987.5,,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1391.25,35,,1113,percent of total billed charges,35% of total billed charges for outpatient setting,3100.5,78,,2480.4,percent of total billed charges,78% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2981.25,75,,2385,percent of total billed charges,75% of total billed charges for outpatient setting,3299.25,83,,2639.4,percent of total billed charges,83% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1556.93,39.17,,1245.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1391.25,3299.25,
ANKLE SYNDESMOSIS REPAIR SYSTEM 46-0023S,778189,CDM,360,RC,C1776,HCPCS,outpatient,,,10200,5100,,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3916.8,38.4,,3133.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3916.8,38.4,,3133.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3570,35,,2856,percent of total billed charges,35% of total billed charges for outpatient setting,7956,78,,6364.8,percent of total billed charges,78% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,8466,83,,6772.8,percent of total billed charges,83% of total billed charges for outpatient setting,5100,50,,4080,percent of total billed charges,50% of total billed charges for outpatient setting,5100,50,,4080,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3995.14,39.17,,3196.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3570,8466,
DRILL BIT 2.5 AR 8943-30,778190,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
DRILL BIT 2.0 AR 8943-16,778191,CDM,278,RC,C1713,HCPCS,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
DRILL BIT 2.6 AR 8943-02,778192,CDM,278,RC,C1713,HCPCS,both,,,340,170,,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.56,38.4,,104.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.56,38.4,,104.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,340,70,,272,percent of total billed charges,70% of total billed charges for outpatient setting,340,70,,272,percent of total billed charges,70% of total billed charges for outpatient setting,340,70,,272,percent of total billed charges,70% of total billed charges for outpatient setting,340,75,,272,percent of total billed charges,75% of total billed charges for outpatient setting,340,75,,272,percent of total billed charges,75% of total billed charges for outpatient setting,340,70,,272,percent of total billed charges,70% of total billed charges for outpatient setting,340,75,,272,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119,35,,95.2,percent of total billed charges,35% of total billed charges for outpatient setting,265.2,78,,212.16,percent of total billed charges,78% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,282.2,83,,225.76,percent of total billed charges,83% of total billed charges for outpatient setting,170,50,,136,percent of total billed charges,50% of total billed charges for outpatient setting,170,50,,136,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.17,39.17,,106.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,119,340,
PLATE -5-HOLE RT DISTAL FIB AR-8943DR-05,778193,CDM,360,RC,,,outpatient,,,4371,2185.5,,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1678.46,38.4,,1342.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1678.46,38.4,,1342.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1529.85,35,,1223.88,percent of total billed charges,35% of total billed charges for outpatient setting,3409.38,78,,2727.504,percent of total billed charges,78% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3627.93,83,,2902.344,percent of total billed charges,83% of total billed charges for outpatient setting,2185.5,50,,1748.4,percent of total billed charges,50% of total billed charges for outpatient setting,2185.5,50,,1748.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1712.03,39.17,,1369.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1529.85,3627.93,
TRANSFORAMINAL EPIDURAL;CERVIC,778194,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
TRANSFORAMINAL EPIDURAL;LUMBAR,778196,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
TRANSFORAMINAL EPIDURAL;LUMBAR,778197,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
BILATERAL MYRINGOTOMY TUBES,778198,CDM,360,RC,,,outpatient,,,1068,534,,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,410.11,38.4,,328.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,410.11,38.4,,328.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,373.8,35,,299.04,percent of total billed charges,35% of total billed charges for outpatient setting,833.04,78,,666.432,percent of total billed charges,78% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,886.44,83,,709.152,percent of total billed charges,83% of total billed charges for outpatient setting,534,50,,427.2,percent of total billed charges,50% of total billed charges for outpatient setting,534,50,,427.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,418.31,39.17,,334.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,373.8,886.44,
"TAH BURCH,SUPRA PUBIC CATH",778201,CDM,360,RC,,,outpatient,,,2264,1132,,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.4,35,,633.92,percent of total billed charges,35% of total billed charges for outpatient setting,1765.92,78,,1412.736,percent of total billed charges,78% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1879.12,83,,1503.296,percent of total billed charges,83% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,886.77,39.17,,709.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,792.4,1879.12,
POSTERIOR REPAIR,778203,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
SPHINCTEROTOMY,778204,CDM,360,RC,,,outpatient,,,1264,632,,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.4,35,,353.92,percent of total billed charges,35% of total billed charges for outpatient setting,985.92,78,,788.736,percent of total billed charges,78% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,1049.12,83,,839.296,percent of total billed charges,83% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495.09,39.17,,396.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,442.4,1049.12,
BRONCHOSCOPY/G-TUBE PLACEMENT,778205,CDM,360,RC,,,outpatient,,,1706,853,,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,655.1,38.4,,524.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,655.1,38.4,,524.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,1279.5,75,,1023.6,percent of total billed charges,75% of total billed charges for outpatient setting,1279.5,75,,1023.6,percent of total billed charges,75% of total billed charges for outpatient setting,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,1279.5,75,,1023.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,597.1,35,,477.68,percent of total billed charges,35% of total billed charges for outpatient setting,1330.68,78,,1064.544,percent of total billed charges,78% of total billed charges for outpatient setting,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,1194.2,70,,955.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1279.5,75,,1023.6,percent of total billed charges,75% of total billed charges for outpatient setting,1415.98,83,,1132.784,percent of total billed charges,83% of total billed charges for outpatient setting,853,50,,682.4,percent of total billed charges,50% of total billed charges for outpatient setting,853,50,,682.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,668.2,39.17,,534.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,597.1,1415.98,
COLONOSCOPY (E),778206,CDM,750,RC,,,outpatient,,,1223,611.5,,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,428.05,35,,342.44,percent of total billed charges,35% of total billed charges for outpatient setting,953.94,78,,763.152,percent of total billed charges,78% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,1015.09,83,,812.072,percent of total billed charges,83% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,479.02,39.17,,383.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,428.05,1015.09,
ENDO (E),778207,CDM,750,RC,,,outpatient,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
CUBITAL TUNNEL RELEASE,778209,CDM,360,RC,,,outpatient,,,3810,1905,,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1463.04,38.4,,1170.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1463.04,38.4,,1170.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,2857.5,75,,2286,percent of total billed charges,75% of total billed charges for outpatient setting,2857.5,75,,2286,percent of total billed charges,75% of total billed charges for outpatient setting,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,2857.5,75,,2286,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1333.5,35,,1066.8,percent of total billed charges,35% of total billed charges for outpatient setting,2971.8,78,,2377.44,percent of total billed charges,78% of total billed charges for outpatient setting,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,2667,70,,2133.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2857.5,75,,2286,percent of total billed charges,75% of total billed charges for outpatient setting,3162.3,83,,2529.84,percent of total billed charges,83% of total billed charges for outpatient setting,1905,50,,1524,percent of total billed charges,50% of total billed charges for outpatient setting,1905,50,,1524,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1492.3,39.17,,1193.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1333.5,3162.3,
"TVH, APR, SSF",778210,CDM,360,RC,,,outpatient,,,2085,1042.5,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,729.75,35,,583.8,percent of total billed charges,35% of total billed charges for outpatient setting,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1730.55,83,,1384.44,percent of total billed charges,83% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.65,39.17,,653.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,729.75,1730.55,
REPAIR TRAUMATIC AMPUTATION/FI,778211,CDM,360,RC,,,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,641,50,,512.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,448.7,1064.06,
EXP OF ABDOMINAL SOFT TISSUE M,778212,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
VIDRAPI (TURKEY BAG),778213,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
DEBRIDEMENT ABD WOUND WITH CLO,778214,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
EXP OF ABDOMINAL WOUND INFECTI,778215,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
"LAP TUBAL, D&C",778216,CDM,360,RC,,,outpatient,,,5490,2745,,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2108.16,38.4,,1686.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2108.16,38.4,,1686.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1921.5,35,,1537.2,percent of total billed charges,35% of total billed charges for outpatient setting,4282.2,78,,3425.76,percent of total billed charges,78% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,3843,70,,3074.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4117.5,75,,3294,percent of total billed charges,75% of total billed charges for outpatient setting,4556.7,83,,3645.36,percent of total billed charges,83% of total billed charges for outpatient setting,2745,50,,2196,percent of total billed charges,50% of total billed charges for outpatient setting,2745,50,,2196,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2150.32,39.17,,1720.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1921.5,4556.7,
EGD/PROCEDURE CANCELLED,778217,CDM,360,RC,,,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
COLONOSCOPY/ATTEMPTED/CANCELLE,778218,CDM,360,RC,,,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.2,35,,25.76,percent of total billed charges,35% of total billed charges for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.04,39.17,,28.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.2,76.36,
"STAGED PROCEDURE, COMPLEX FLAP",778219,CDM,360,RC,,,outpatient,,,1365,682.5,,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,524.16,38.4,,419.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,524.16,38.4,,419.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,477.75,35,,382.2,percent of total billed charges,35% of total billed charges for outpatient setting,1064.7,78,,851.76,percent of total billed charges,78% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,70,,764.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1023.75,75,,819,percent of total billed charges,75% of total billed charges for outpatient setting,1132.95,83,,906.36,percent of total billed charges,83% of total billed charges for outpatient setting,682.5,50,,546,percent of total billed charges,50% of total billed charges for outpatient setting,682.5,50,,546,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,534.64,39.17,,427.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,477.75,1132.95,
D&C EMERGENCY HYSTERECTOMY,778221,CDM,360,RC,,,outpatient,,,2532,1266,,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,972.29,38.4,,777.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,972.29,38.4,,777.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,886.2,35,,708.96,percent of total billed charges,35% of total billed charges for outpatient setting,1974.96,78,,1579.968,percent of total billed charges,78% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,2101.56,83,,1681.248,percent of total billed charges,83% of total billed charges for outpatient setting,1266,50,,1012.8,percent of total billed charges,50% of total billed charges for outpatient setting,1266,50,,1012.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,991.74,39.17,,793.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,886.2,2101.56,
G-TUBE & TRACH PLACEMENT,778222,CDM,360,RC,,,outpatient,,,2138,1069,,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,820.99,38.4,,656.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.3,35,,598.64,percent of total billed charges,35% of total billed charges for outpatient setting,1667.64,78,,1334.112,percent of total billed charges,78% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,1496.6,70,,1197.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1603.5,75,,1282.8,percent of total billed charges,75% of total billed charges for outpatient setting,1774.54,83,,1419.632,percent of total billed charges,83% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,1069,50,,855.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,837.41,39.17,,669.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,748.3,1774.54,
"BMT, ADENOIDECTOMY",778223,CDM,360,RC,,,outpatient,,,1235,617.5,,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,474.24,38.4,,379.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,474.24,38.4,,379.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,432.25,35,,345.8,percent of total billed charges,35% of total billed charges for outpatient setting,963.3,78,,770.64,percent of total billed charges,78% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,864.5,70,,691.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,926.25,75,,741,percent of total billed charges,75% of total billed charges for outpatient setting,1025.05,83,,820.04,percent of total billed charges,83% of total billed charges for outpatient setting,617.5,50,,494,percent of total billed charges,50% of total billed charges for outpatient setting,617.5,50,,494,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.72,39.17,,386.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,432.25,1025.05,
ARTHROPLASTY TOES,778224,CDM,360,RC,,,outpatient,,,2264,1132,,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,869.38,38.4,,695.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.4,35,,633.92,percent of total billed charges,35% of total billed charges for outpatient setting,1765.92,78,,1412.736,percent of total billed charges,78% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,1584.8,70,,1267.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1698,75,,1358.4,percent of total billed charges,75% of total billed charges for outpatient setting,1879.12,83,,1503.296,percent of total billed charges,83% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,1132,50,,905.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,886.77,39.17,,709.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,792.4,1879.12,
"REPAIR BLOOD VESSELL, DIRECT,",778225,CDM,360,RC,,,outpatient,,,1688,844,,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,648.19,38.4,,518.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,648.19,38.4,,518.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,1266,75,,1012.8,percent of total billed charges,75% of total billed charges for outpatient setting,1266,75,,1012.8,percent of total billed charges,75% of total billed charges for outpatient setting,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,1266,75,,1012.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,590.8,35,,472.64,percent of total billed charges,35% of total billed charges for outpatient setting,1316.64,78,,1053.312,percent of total billed charges,78% of total billed charges for outpatient setting,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,1181.6,70,,945.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1266,75,,1012.8,percent of total billed charges,75% of total billed charges for outpatient setting,1401.04,83,,1120.832,percent of total billed charges,83% of total billed charges for outpatient setting,844,50,,675.2,percent of total billed charges,50% of total billed charges for outpatient setting,844,50,,675.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,661.15,39.17,,528.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,590.8,1401.04,
ASNIS SCREWS/HIP PINNING,778227,CDM,360,RC,,,outpatient,,,3152,1576,,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1210.37,38.4,,968.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1210.37,38.4,,968.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,2364,75,,1891.2,percent of total billed charges,75% of total billed charges for outpatient setting,2364,75,,1891.2,percent of total billed charges,75% of total billed charges for outpatient setting,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,2364,75,,1891.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1103.2,35,,882.56,percent of total billed charges,35% of total billed charges for outpatient setting,2458.56,78,,1966.848,percent of total billed charges,78% of total billed charges for outpatient setting,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,2206.4,70,,1765.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2364,75,,1891.2,percent of total billed charges,75% of total billed charges for outpatient setting,2616.16,83,,2092.928,percent of total billed charges,83% of total billed charges for outpatient setting,1576,50,,1260.8,percent of total billed charges,50% of total billed charges for outpatient setting,1576,50,,1260.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1234.58,39.17,,987.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1103.2,2616.16,
HIP PROSTHESIS,778228,CDM,360,RC,,,outpatient,,,2859,1429.5,,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1097.86,38.4,,878.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1097.86,38.4,,878.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,2144.25,75,,1715.4,percent of total billed charges,75% of total billed charges for outpatient setting,2144.25,75,,1715.4,percent of total billed charges,75% of total billed charges for outpatient setting,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,2144.25,75,,1715.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1000.65,35,,800.52,percent of total billed charges,35% of total billed charges for outpatient setting,2230.02,78,,1784.016,percent of total billed charges,78% of total billed charges for outpatient setting,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,2001.3,70,,1601.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2144.25,75,,1715.4,percent of total billed charges,75% of total billed charges for outpatient setting,2372.97,83,,1898.376,percent of total billed charges,83% of total billed charges for outpatient setting,1429.5,50,,1143.6,percent of total billed charges,50% of total billed charges for outpatient setting,1429.5,50,,1143.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1119.82,39.17,,895.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1000.65,2372.97,
REMOVAL OF BILATERAL MYRINGOTO,778229,CDM,360,RC,,,outpatient,,,515,257.5,,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.25,35,,144.2,percent of total billed charges,35% of total billed charges for outpatient setting,401.7,78,,321.36,percent of total billed charges,78% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,427.45,83,,341.96,percent of total billed charges,83% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.72,39.17,,161.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,180.25,427.45,
UPPER WARMING BLANKET,778231,CDM,270,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
RANGER FLUID WARM TUBE,778232,CDM,270,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
FULL BODY WARMING BLANKET,778233,CDM,270,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
REMOVAL OF RETAINED SUTURE,778234,CDM,360,RC,,,outpatient,,,275,137.5,,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.6,38.4,,84.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.6,38.4,,84.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,206.25,75,,165,percent of total billed charges,75% of total billed charges for outpatient setting,206.25,75,,165,percent of total billed charges,75% of total billed charges for outpatient setting,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,206.25,75,,165,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.25,35,,77,percent of total billed charges,35% of total billed charges for outpatient setting,214.5,78,,171.6,percent of total billed charges,78% of total billed charges for outpatient setting,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,192.5,70,,154,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,206.25,75,,165,percent of total billed charges,75% of total billed charges for outpatient setting,228.25,83,,182.6,percent of total billed charges,83% of total billed charges for outpatient setting,137.5,50,,110,percent of total billed charges,50% of total billed charges for outpatient setting,137.5,50,,110,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.71,39.17,,86.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,96.25,228.25,
ASPERATION BLADDER W/INSERTION,778235,CDM,360,RC,,,outpatient,,,1338,669,,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,513.79,38.4,,411.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,513.79,38.4,,411.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,1003.5,75,,802.8,percent of total billed charges,75% of total billed charges for outpatient setting,1003.5,75,,802.8,percent of total billed charges,75% of total billed charges for outpatient setting,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,1003.5,75,,802.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,468.3,35,,374.64,percent of total billed charges,35% of total billed charges for outpatient setting,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges for outpatient setting,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,936.6,70,,749.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1003.5,75,,802.8,percent of total billed charges,75% of total billed charges for outpatient setting,1110.54,83,,888.432,percent of total billed charges,83% of total billed charges for outpatient setting,669,50,,535.2,percent of total billed charges,50% of total billed charges for outpatient setting,669,50,,535.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,524.07,39.17,,419.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,468.3,1110.54,
SCREW 3.5X14MM CORTICAL AR 8835-14,778236,CDM,278,RC,C1713,HCPCS,both,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.5,456.5,
SCREW 3.5X12MM CORTICAL AR 8835-12,778237,CDM,278,RC,C1713,HCPCS,both,,,1285,642.5,,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,899.5,70,,719.6,percent of total billed charges,70% of billed charges for implant carveouts,1028,80,,822.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,449.75,35,,359.8,percent of total billed charges,35% of total billed charges for outpatient setting,1002.3,78,,801.84,percent of total billed charges,78% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,1066.55,83,,853.24,percent of total billed charges,83% of total billed charges for outpatient setting,642.5,50,,514,percent of total billed charges,50% of total billed charges for outpatient setting,642.5,50,,514,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,503.31,39.17,,402.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,449.75,1066.55,
SCREW 3.5X16MM CORTICAL AR 8827CL-16,778238,CDM,278,RC,C1713,HCPCS,both,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,385,70,,308,percent of total billed charges,70% of billed charges for implant carveouts,440,80,,352,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.5,456.5,
BILATERAL TOTAL KNEE REPLACEME,778245,CDM,360,RC,,,outpatient,,,7131,3565.5,,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2738.3,38.4,,2190.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2738.3,38.4,,2190.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,5348.25,75,,4278.6,percent of total billed charges,75% of total billed charges for outpatient setting,5348.25,75,,4278.6,percent of total billed charges,75% of total billed charges for outpatient setting,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,5348.25,75,,4278.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2495.85,35,,1996.68,percent of total billed charges,35% of total billed charges for outpatient setting,5562.18,78,,4449.744,percent of total billed charges,78% of total billed charges for outpatient setting,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,4991.7,70,,3993.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5348.25,75,,4278.6,percent of total billed charges,75% of total billed charges for outpatient setting,5918.73,83,,4734.984,percent of total billed charges,83% of total billed charges for outpatient setting,3565.5,50,,2852.4,percent of total billed charges,50% of total billed charges for outpatient setting,3565.5,50,,2852.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2793.07,39.17,,2234.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2495.85,5918.73,
WRIST EXTERNAL FIXATOR,778246,CDM,360,RC,,,outpatient,,,3134,1567,,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1203.46,38.4,,962.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1203.46,38.4,,962.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1096.9,35,,877.52,percent of total billed charges,35% of total billed charges for outpatient setting,2444.52,78,,1955.616,percent of total billed charges,78% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2601.22,83,,2080.976,percent of total billed charges,83% of total billed charges for outpatient setting,1567,50,,1253.6,percent of total billed charges,50% of total billed charges for outpatient setting,1567,50,,1253.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1227.53,39.17,,982.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1096.9,2601.22,
REMOVAL/BIVALVING OF BOOT OR B,778247,CDM,360,RC,,,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.85,35,,53.48,percent of total billed charges,35% of total billed charges for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.81,39.17,,59.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.85,158.53,
PARTIAL VAGECTOMY,778255,CDM,360,RC,,,outpatient,,,1184,592,,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.66,38.4,,363.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,454.66,38.4,,363.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,414.4,35,,331.52,percent of total billed charges,35% of total billed charges for outpatient setting,923.52,78,,738.816,percent of total billed charges,78% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,828.8,70,,663.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,888,75,,710.4,percent of total billed charges,75% of total billed charges for outpatient setting,982.72,83,,786.176,percent of total billed charges,83% of total billed charges for outpatient setting,592,50,,473.6,percent of total billed charges,50% of total billed charges for outpatient setting,592,50,,473.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,463.75,39.17,,371,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,414.4,982.72,
TIB/FIB IM MAIL,778256,CDM,360,RC,,,outpatient,,,3854,1927,,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1479.94,38.4,,1183.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1479.94,38.4,,1183.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1348.9,35,,1079.12,percent of total billed charges,35% of total billed charges for outpatient setting,3006.12,78,,2404.896,percent of total billed charges,78% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,2697.8,70,,2158.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2890.5,75,,2312.4,percent of total billed charges,75% of total billed charges for outpatient setting,3198.82,83,,2559.056,percent of total billed charges,83% of total billed charges for outpatient setting,1927,50,,1541.6,percent of total billed charges,50% of total billed charges for outpatient setting,1927,50,,1541.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1509.54,39.17,,1207.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1348.9,3198.82,
CHANGE TRACH,778257,CDM,360,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
CAST CHANGE,778258,CDM,360,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
RECTOCELE/HEMORROIDECTOMY,778259,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
"DIAG LAP, SUCTION D&C",778260,CDM,360,RC,,,outpatient,,,4425,2212.5,,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1699.2,38.4,,1359.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1699.2,38.4,,1359.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,35,,1239,percent of total billed charges,35% of total billed charges for outpatient setting,3451.5,78,,2761.2,percent of total billed charges,78% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3672.75,83,,2938.2,percent of total billed charges,83% of total billed charges for outpatient setting,2212.5,50,,1770,percent of total billed charges,50% of total billed charges for outpatient setting,2212.5,50,,1770,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1733.18,39.17,,1386.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1548.75,3672.75,
TRACH REVISION,778261,CDM,360,RC,,,outpatient,,,717,358.5,,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.95,35,,200.76,percent of total billed charges,35% of total billed charges for outpatient setting,559.26,78,,447.408,percent of total billed charges,78% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,595.11,83,,476.088,percent of total billed charges,83% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,280.84,39.17,,224.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,250.95,595.11,
CORE BIOPSY PROCEDURE,778262,CDM,360,RC,19100,HCPCS,outpatient,,,846,423,,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,35,,236.88,percent of total billed charges,35% of total billed charges for outpatient setting,659.88,78,,527.904,percent of total billed charges,78% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,702.18,83,,561.744,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.36,39.17,,265.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,2175,
CHEST TUBE INSERTION,778263,CDM,360,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
MICROSURGICAL TUBAL RECONSTRUC,778265,CDM,360,RC,,,outpatient,,,2624,1312,,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1007.62,38.4,,806.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1007.62,38.4,,806.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,1968,75,,1574.4,percent of total billed charges,75% of total billed charges for outpatient setting,1968,75,,1574.4,percent of total billed charges,75% of total billed charges for outpatient setting,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,1968,75,,1574.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.4,35,,734.72,percent of total billed charges,35% of total billed charges for outpatient setting,2046.72,78,,1637.376,percent of total billed charges,78% of total billed charges for outpatient setting,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,1836.8,70,,1469.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1968,75,,1574.4,percent of total billed charges,75% of total billed charges for outpatient setting,2177.92,83,,1742.336,percent of total billed charges,83% of total billed charges for outpatient setting,1312,50,,1049.6,percent of total billed charges,50% of total billed charges for outpatient setting,1312,50,,1049.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1027.77,39.17,,822.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,918.4,2177.92,
DIAGLAP; D & C,778266,CDM,360,RC,,,outpatient,,,4147,2073.5,,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1592.45,38.4,,1273.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1592.45,38.4,,1273.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,3110.25,75,,2488.2,percent of total billed charges,75% of total billed charges for outpatient setting,3110.25,75,,2488.2,percent of total billed charges,75% of total billed charges for outpatient setting,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,3110.25,75,,2488.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1451.45,35,,1161.16,percent of total billed charges,35% of total billed charges for outpatient setting,3234.66,78,,2587.728,percent of total billed charges,78% of total billed charges for outpatient setting,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,2902.9,70,,2322.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3110.25,75,,2488.2,percent of total billed charges,75% of total billed charges for outpatient setting,3442.01,83,,2753.608,percent of total billed charges,83% of total billed charges for outpatient setting,2073.5,50,,1658.8,percent of total billed charges,50% of total billed charges for outpatient setting,2073.5,50,,1658.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1624.3,39.17,,1299.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1451.45,3442.01,
REMOVAL EXTERNAL FIXATOR,778269,CDM,360,RC,,,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,229.25,543.65,
D1 COMPARTMENT RELEASE,778270,CDM,360,RC,,,outpatient,,,1585,792.5,,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,554.75,35,,443.8,percent of total billed charges,35% of total billed charges for outpatient setting,1236.3,78,,989.04,percent of total billed charges,78% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1315.55,83,,1052.44,percent of total billed charges,83% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,620.81,39.17,,496.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,554.75,1315.55,
BRONCH/CHEST TUBE INSERTION,778271,CDM,360,RC,,,outpatient,,,1801,900.5,,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,691.58,38.4,,553.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,691.58,38.4,,553.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,1350.75,75,,1080.6,percent of total billed charges,75% of total billed charges for outpatient setting,1350.75,75,,1080.6,percent of total billed charges,75% of total billed charges for outpatient setting,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,1350.75,75,,1080.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,630.35,35,,504.28,percent of total billed charges,35% of total billed charges for outpatient setting,1404.78,78,,1123.824,percent of total billed charges,78% of total billed charges for outpatient setting,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,1260.7,70,,1008.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1350.75,75,,1080.6,percent of total billed charges,75% of total billed charges for outpatient setting,1494.83,83,,1195.864,percent of total billed charges,83% of total billed charges for outpatient setting,900.5,50,,720.4,percent of total billed charges,50% of total billed charges for outpatient setting,900.5,50,,720.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,705.41,39.17,,564.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,630.35,1494.83,
MP JOINT REPAIR,778272,CDM,360,RC,,,outpatient,,,2345,1172.5,,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,900.48,38.4,,720.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,900.48,38.4,,720.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,1758.75,75,,1407,percent of total billed charges,75% of total billed charges for outpatient setting,1758.75,75,,1407,percent of total billed charges,75% of total billed charges for outpatient setting,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,1758.75,75,,1407,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,820.75,35,,656.6,percent of total billed charges,35% of total billed charges for outpatient setting,1829.1,78,,1463.28,percent of total billed charges,78% of total billed charges for outpatient setting,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,1641.5,70,,1313.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1758.75,75,,1407,percent of total billed charges,75% of total billed charges for outpatient setting,1946.35,83,,1557.08,percent of total billed charges,83% of total billed charges for outpatient setting,1172.5,50,,938,percent of total billed charges,50% of total billed charges for outpatient setting,1172.5,50,,938,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.49,39.17,,734.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,820.75,1946.35,
TURBT RANDOM BLADDER BIOPSY,778273,CDM,360,RC,,,outpatient,,,2141,1070.5,,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,822.14,38.4,,657.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,822.14,38.4,,657.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,1605.75,75,,1284.6,percent of total billed charges,75% of total billed charges for outpatient setting,1605.75,75,,1284.6,percent of total billed charges,75% of total billed charges for outpatient setting,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,1605.75,75,,1284.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,749.35,35,,599.48,percent of total billed charges,35% of total billed charges for outpatient setting,1669.98,78,,1335.984,percent of total billed charges,78% of total billed charges for outpatient setting,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,1498.7,70,,1198.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1605.75,75,,1284.6,percent of total billed charges,75% of total billed charges for outpatient setting,1777.03,83,,1421.624,percent of total billed charges,83% of total billed charges for outpatient setting,1070.5,50,,856.4,percent of total billed charges,50% of total billed charges for outpatient setting,1070.5,50,,856.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,838.58,39.17,,670.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,749.35,1777.03,
AMPUTATION & G TUBE,778275,CDM,360,RC,,,outpatient,,,2270,1135,,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,871.68,38.4,,697.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,871.68,38.4,,697.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,1702.5,75,,1362,percent of total billed charges,75% of total billed charges for outpatient setting,1702.5,75,,1362,percent of total billed charges,75% of total billed charges for outpatient setting,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,1702.5,75,,1362,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,794.5,35,,635.6,percent of total billed charges,35% of total billed charges for outpatient setting,1770.6,78,,1416.48,percent of total billed charges,78% of total billed charges for outpatient setting,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,1589,70,,1271.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1702.5,75,,1362,percent of total billed charges,75% of total billed charges for outpatient setting,1884.1,83,,1507.28,percent of total billed charges,83% of total billed charges for outpatient setting,1135,50,,908,percent of total billed charges,50% of total billed charges for outpatient setting,1135,50,,908,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,889.11,39.17,,711.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,794.5,1884.1,
EXCISION SKIN LESION/PACU,778276,CDM,360,RC,,,outpatient,,,359,179.5,,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.86,38.4,,110.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.86,38.4,,110.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,269.25,75,,215.4,percent of total billed charges,75% of total billed charges for outpatient setting,269.25,75,,215.4,percent of total billed charges,75% of total billed charges for outpatient setting,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,269.25,75,,215.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.65,35,,100.52,percent of total billed charges,35% of total billed charges for outpatient setting,280.02,78,,224.016,percent of total billed charges,78% of total billed charges for outpatient setting,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,251.3,70,,201.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.25,75,,215.4,percent of total billed charges,75% of total billed charges for outpatient setting,297.97,83,,238.376,percent of total billed charges,83% of total billed charges for outpatient setting,179.5,50,,143.6,percent of total billed charges,50% of total billed charges for outpatient setting,179.5,50,,143.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,140.62,39.17,,112.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,125.65,297.97,
RECTAL PDYPECTOMY,778277,CDM,360,RC,,,outpatient,,,1264,632,,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.4,35,,353.92,percent of total billed charges,35% of total billed charges for outpatient setting,985.92,78,,788.736,percent of total billed charges,78% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,1049.12,83,,839.296,percent of total billed charges,83% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495.09,39.17,,396.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,442.4,1049.12,
OPEN CHOLECYSTECTOMY W/LOC. CB,778278,CDM,360,RC,,,outpatient,,,2933,1466.5,,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1126.27,38.4,,901.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1126.27,38.4,,901.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,2199.75,75,,1759.8,percent of total billed charges,75% of total billed charges for outpatient setting,2199.75,75,,1759.8,percent of total billed charges,75% of total billed charges for outpatient setting,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,2199.75,75,,1759.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1026.55,35,,821.24,percent of total billed charges,35% of total billed charges for outpatient setting,2287.74,78,,1830.192,percent of total billed charges,78% of total billed charges for outpatient setting,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,2053.1,70,,1642.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2199.75,75,,1759.8,percent of total billed charges,75% of total billed charges for outpatient setting,2434.39,83,,1947.512,percent of total billed charges,83% of total billed charges for outpatient setting,1466.5,50,,1173.2,percent of total billed charges,50% of total billed charges for outpatient setting,1466.5,50,,1173.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1148.8,39.17,,919.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1026.55,2434.39,
EXP LAP. REMOVAL OF FOREIGN BO,778279,CDM,360,RC,,,outpatient,,,2360,1180,,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,906.24,38.4,,724.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,906.24,38.4,,724.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,826,35,,660.8,percent of total billed charges,35% of total billed charges for outpatient setting,1840.8,78,,1472.64,percent of total billed charges,78% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1958.8,83,,1567.04,percent of total billed charges,83% of total billed charges for outpatient setting,1180,50,,944,percent of total billed charges,50% of total billed charges for outpatient setting,1180,50,,944,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,924.36,39.17,,739.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,826,1958.8,
FINE NEEDLE ASPIRATION W/O IMA,778280,CDM,360,RC,10021,HCPCS,outpatient,,,304,152,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.4,35,,85.12,percent of total billed charges,35% of total billed charges for outpatient setting,237.12,78,,189.696,percent of total billed charges,78% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,252.32,83,,201.856,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.07,39.17,,95.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.4,659,
"EXP LAP, BRONCH, COLONOSCOPY",778281,CDM,360,RC,,,outpatient,,,3171,1585.5,,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1217.66,38.4,,974.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1217.66,38.4,,974.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,2378.25,75,,1902.6,percent of total billed charges,75% of total billed charges for outpatient setting,2378.25,75,,1902.6,percent of total billed charges,75% of total billed charges for outpatient setting,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,2378.25,75,,1902.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1109.85,35,,887.88,percent of total billed charges,35% of total billed charges for outpatient setting,2473.38,78,,1978.704,percent of total billed charges,78% of total billed charges for outpatient setting,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,2219.7,70,,1775.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2378.25,75,,1902.6,percent of total billed charges,75% of total billed charges for outpatient setting,2631.93,83,,2105.544,percent of total billed charges,83% of total billed charges for outpatient setting,1585.5,50,,1268.4,percent of total billed charges,50% of total billed charges for outpatient setting,1585.5,50,,1268.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1242.01,39.17,,993.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1109.85,2631.93,
EXCISION OF BARTHOUN'S CYST,778282,CDM,360,RC,,,outpatient,,,1405,702.5,,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.75,35,,393.4,percent of total billed charges,35% of total billed charges for outpatient setting,1095.9,78,,876.72,percent of total billed charges,78% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1166.15,83,,932.92,percent of total billed charges,83% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,550.31,39.17,,440.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,491.75,1166.15,
JOINT/LIGAMENT RELEASE,778283,CDM,360,RC,,,outpatient,,,1283,641.5,,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,492.67,38.4,,394.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.67,38.4,,394.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,962.25,75,,769.8,percent of total billed charges,75% of total billed charges for outpatient setting,962.25,75,,769.8,percent of total billed charges,75% of total billed charges for outpatient setting,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,962.25,75,,769.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,449.05,35,,359.24,percent of total billed charges,35% of total billed charges for outpatient setting,1000.74,78,,800.592,percent of total billed charges,78% of total billed charges for outpatient setting,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,898.1,70,,718.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,962.25,75,,769.8,percent of total billed charges,75% of total billed charges for outpatient setting,1064.89,83,,851.912,percent of total billed charges,83% of total billed charges for outpatient setting,641.5,50,,513.2,percent of total billed charges,50% of total billed charges for outpatient setting,641.5,50,,513.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.52,39.17,,402.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,449.05,1064.89,
EXC. OF PILONIDAL CYST,778284,CDM,360,RC,,,outpatient,,,2950,1475,,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1132.8,38.4,,906.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1132.8,38.4,,906.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,2212.5,75,,1770,percent of total billed charges,75% of total billed charges for outpatient setting,2212.5,75,,1770,percent of total billed charges,75% of total billed charges for outpatient setting,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,2212.5,75,,1770,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1032.5,35,,826,percent of total billed charges,35% of total billed charges for outpatient setting,2301,78,,1840.8,percent of total billed charges,78% of total billed charges for outpatient setting,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,2065,70,,1652,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2212.5,75,,1770,percent of total billed charges,75% of total billed charges for outpatient setting,2448.5,83,,1958.8,percent of total billed charges,83% of total billed charges for outpatient setting,1475,50,,1180,percent of total billed charges,50% of total billed charges for outpatient setting,1475,50,,1180,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1155.46,39.17,,924.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1032.5,2448.5,
BIOPSY LESION,778285,CDM,360,RC,,,outpatient,,,164,82,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.4,35,,45.92,percent of total billed charges,35% of total billed charges for outpatient setting,127.92,78,,102.336,percent of total billed charges,78% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,136.12,83,,108.896,percent of total billed charges,83% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.24,39.17,,51.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.4,136.12,
BIOPSY LESION SKIN ADD ON,778286,CDM,360,RC,,,outpatient,,,230,115,,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.5,35,,64.4,percent of total billed charges,35% of total billed charges for outpatient setting,179.4,78,,143.52,percent of total billed charges,78% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,190.9,83,,152.72,percent of total billed charges,83% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.09,39.17,,72.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.5,190.9,
RETROWASH,778288,CDM,360,RC,,,outpatient,,,1274,637,,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,489.22,38.4,,391.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,489.22,38.4,,391.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,445.9,35,,356.72,percent of total billed charges,35% of total billed charges for outpatient setting,993.72,78,,794.976,percent of total billed charges,78% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,891.8,70,,713.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,955.5,75,,764.4,percent of total billed charges,75% of total billed charges for outpatient setting,1057.42,83,,845.936,percent of total billed charges,83% of total billed charges for outpatient setting,637,50,,509.6,percent of total billed charges,50% of total billed charges for outpatient setting,637,50,,509.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,499,39.17,,399.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,445.9,1057.42,
INSERTION RUSH ROD,778289,CDM,360,RC,,,outpatient,,,3137,1568.5,,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1204.61,38.4,,963.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1204.61,38.4,,963.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,2352.75,75,,1882.2,percent of total billed charges,75% of total billed charges for outpatient setting,2352.75,75,,1882.2,percent of total billed charges,75% of total billed charges for outpatient setting,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,2352.75,75,,1882.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1097.95,35,,878.36,percent of total billed charges,35% of total billed charges for outpatient setting,2446.86,78,,1957.488,percent of total billed charges,78% of total billed charges for outpatient setting,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,2195.9,70,,1756.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2352.75,75,,1882.2,percent of total billed charges,75% of total billed charges for outpatient setting,2603.71,83,,2082.968,percent of total billed charges,83% of total billed charges for outpatient setting,1568.5,50,,1254.8,percent of total billed charges,50% of total billed charges for outpatient setting,1568.5,50,,1254.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1228.7,39.17,,982.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1097.95,2603.71,
DIAG. LAPAROSCOPY CONVERTED OP,778291,CDM,360,RC,,,outpatient,,,5976,2988,,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2294.78,38.4,,1835.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2294.78,38.4,,1835.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,4482,75,,3585.6,percent of total billed charges,75% of total billed charges for outpatient setting,4482,75,,3585.6,percent of total billed charges,75% of total billed charges for outpatient setting,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,4482,75,,3585.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2091.6,35,,1673.28,percent of total billed charges,35% of total billed charges for outpatient setting,4661.28,78,,3729.024,percent of total billed charges,78% of total billed charges for outpatient setting,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,4183.2,70,,3346.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4482,75,,3585.6,percent of total billed charges,75% of total billed charges for outpatient setting,4960.08,83,,3968.064,percent of total billed charges,83% of total billed charges for outpatient setting,2988,50,,2390.4,percent of total billed charges,50% of total billed charges for outpatient setting,2988,50,,2390.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2340.68,39.17,,1872.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2091.6,4960.08,
ORIF FINGER W/ K-WIRE,778294,CDM,360,RC,,,outpatient,,,2131,1065.5,,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,818.3,38.4,,654.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,818.3,38.4,,654.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,1598.25,75,,1278.6,percent of total billed charges,75% of total billed charges for outpatient setting,1598.25,75,,1278.6,percent of total billed charges,75% of total billed charges for outpatient setting,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,1598.25,75,,1278.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,745.85,35,,596.68,percent of total billed charges,35% of total billed charges for outpatient setting,1662.18,78,,1329.744,percent of total billed charges,78% of total billed charges for outpatient setting,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,1491.7,70,,1193.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1598.25,75,,1278.6,percent of total billed charges,75% of total billed charges for outpatient setting,1768.73,83,,1414.984,percent of total billed charges,83% of total billed charges for outpatient setting,1065.5,50,,852.4,percent of total billed charges,50% of total billed charges for outpatient setting,1065.5,50,,852.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.67,39.17,,667.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,745.85,1768.73,
BURCH PROCEDURE,778295,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
DEBRIDEMENT W/SKIN GRAFTING,778296,CDM,360,RC,,,outpatient,,,1436,718,,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,551.42,38.4,,441.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,551.42,38.4,,441.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,502.6,35,,402.08,percent of total billed charges,35% of total billed charges for outpatient setting,1120.08,78,,896.064,percent of total billed charges,78% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,1005.2,70,,804.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1077,75,,861.6,percent of total billed charges,75% of total billed charges for outpatient setting,1191.88,83,,953.504,percent of total billed charges,83% of total billed charges for outpatient setting,718,50,,574.4,percent of total billed charges,50% of total billed charges for outpatient setting,718,50,,574.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.45,39.17,,449.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,502.6,1191.88,
FISTULOTOMY & COLONOSCOPY,778298,CDM,360,RC,,,outpatient,,,1998,999,,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,767.23,38.4,,613.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,767.23,38.4,,613.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,1498.5,75,,1198.8,percent of total billed charges,75% of total billed charges for outpatient setting,1498.5,75,,1198.8,percent of total billed charges,75% of total billed charges for outpatient setting,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,1498.5,75,,1198.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,699.3,35,,559.44,percent of total billed charges,35% of total billed charges for outpatient setting,1558.44,78,,1246.752,percent of total billed charges,78% of total billed charges for outpatient setting,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,1398.6,70,,1118.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1498.5,75,,1198.8,percent of total billed charges,75% of total billed charges for outpatient setting,1658.34,83,,1326.672,percent of total billed charges,83% of total billed charges for outpatient setting,999,50,,799.2,percent of total billed charges,50% of total billed charges for outpatient setting,999,50,,799.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,782.57,39.17,,626.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,699.3,1658.34,
GROIN EXPLORATION,778299,CDM,360,RC,,,outpatient,,,1628,814,,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,625.15,38.4,,500.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,625.15,38.4,,500.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,569.8,35,,455.84,percent of total billed charges,35% of total billed charges for outpatient setting,1269.84,78,,1015.872,percent of total billed charges,78% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1351.24,83,,1080.992,percent of total billed charges,83% of total billed charges for outpatient setting,814,50,,651.2,percent of total billed charges,50% of total billed charges for outpatient setting,814,50,,651.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,637.65,39.17,,510.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,569.8,1351.24,
GROSHONG 7 FR. CATH KIT,778300,CDM,270,RC,,,outpatient,,,555,277.5,,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,213.12,38.4,,170.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.12,38.4,,170.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,416.25,75,,333,percent of total billed charges,75% of total billed charges for outpatient setting,416.25,75,,333,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,416.25,75,,333,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.25,35,,155.4,percent of total billed charges,35% of total billed charges for outpatient setting,432.9,78,,346.32,percent of total billed charges,78% of total billed charges for outpatient setting,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,388.5,70,,310.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.25,75,,333,percent of total billed charges,75% of total billed charges for outpatient setting,460.65,83,,368.52,percent of total billed charges,83% of total billed charges for outpatient setting,277.5,50,,222,percent of total billed charges,50% of total billed charges for outpatient setting,277.5,50,,222,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.38,39.17,,173.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,194.25,460.65,
INSERTION OF GROSHONG CATH,778301,CDM,360,RC,,,outpatient,,,2342,1171,,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,819.7,35,,655.76,percent of total billed charges,35% of total billed charges for outpatient setting,1826.76,78,,1461.408,percent of total billed charges,78% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1943.86,83,,1555.088,percent of total billed charges,83% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.32,39.17,,733.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,819.7,1943.86,
REMOVAL OF FOREIGN BODY IN MUS,778302,CDM,360,RC,,,outpatient,,,1867,933.5,,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.93,38.4,,573.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,716.93,38.4,,573.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,1400.25,75,,1120.2,percent of total billed charges,75% of total billed charges for outpatient setting,1400.25,75,,1120.2,percent of total billed charges,75% of total billed charges for outpatient setting,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,1400.25,75,,1120.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,653.45,35,,522.76,percent of total billed charges,35% of total billed charges for outpatient setting,1456.26,78,,1165.008,percent of total billed charges,78% of total billed charges for outpatient setting,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,1306.9,70,,1045.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1400.25,75,,1120.2,percent of total billed charges,75% of total billed charges for outpatient setting,1549.61,83,,1239.688,percent of total billed charges,83% of total billed charges for outpatient setting,933.5,50,,746.8,percent of total billed charges,50% of total billed charges for outpatient setting,933.5,50,,746.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.27,39.17,,585.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,653.45,1549.61,
REMOVAL OF EAR WAX,778303,CDM,360,RC,,,outpatient,,,535,267.5,,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.44,38.4,,164.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,205.44,38.4,,164.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,401.25,75,,321,percent of total billed charges,75% of total billed charges for outpatient setting,401.25,75,,321,percent of total billed charges,75% of total billed charges for outpatient setting,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,401.25,75,,321,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.25,35,,149.8,percent of total billed charges,35% of total billed charges for outpatient setting,417.3,78,,333.84,percent of total billed charges,78% of total billed charges for outpatient setting,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,374.5,70,,299.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,401.25,75,,321,percent of total billed charges,75% of total billed charges for outpatient setting,444.05,83,,355.24,percent of total billed charges,83% of total billed charges for outpatient setting,267.5,50,,214,percent of total billed charges,50% of total billed charges for outpatient setting,267.5,50,,214,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,209.55,39.17,,167.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,187.25,444.05,
GELFOAM,778305,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
DEBRIDE ABDOM WALL,778306,CDM,360,RC,11005,HCPCS,outpatient,,,2041,1020.5,,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,2041,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,783.74,38.4,,626.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,783.74,38.4,,626.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,1530.75,75,,1224.6,percent of total billed charges,75% of total billed charges for outpatient setting,1530.75,75,,1224.6,percent of total billed charges,75% of total billed charges for outpatient setting,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,1530.75,75,,1224.6,percent of total billed charges,75% of total billed charges for outpatient setting,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,714.35,35,,571.48,percent of total billed charges,35% of total billed charges for outpatient setting,1591.98,78,,1273.584,percent of total billed charges,78% of total billed charges for outpatient setting,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,1428.7,70,,1142.96,percent of total billed charges,70% of total billed charges for outpatient setting,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1530.75,75,,1224.6,percent of total billed charges,75% of total billed charges for outpatient setting,1694.03,83,,1355.224,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,799.41,39.17,,639.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2041,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,714.35,2175,
LAP CHOLECYSTECTOMY / VASECTOM,778307,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
CLOSURE OF COLOSTOMY,778308,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
REMOVAL OF PLATE SCREWS,778309,CDM,360,RC,,,outpatient,,,3350,1675,,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1286.4,38.4,,1029.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1286.4,38.4,,1029.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,2512.5,75,,2010,percent of total billed charges,75% of total billed charges for outpatient setting,2512.5,75,,2010,percent of total billed charges,75% of total billed charges for outpatient setting,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,2512.5,75,,2010,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1172.5,35,,938,percent of total billed charges,35% of total billed charges for outpatient setting,2613,78,,2090.4,percent of total billed charges,78% of total billed charges for outpatient setting,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,2345,70,,1876,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2512.5,75,,2010,percent of total billed charges,75% of total billed charges for outpatient setting,2780.5,83,,2224.4,percent of total billed charges,83% of total billed charges for outpatient setting,1675,50,,1340,percent of total billed charges,50% of total billed charges for outpatient setting,1675,50,,1340,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1312.13,39.17,,1049.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1172.5,2780.5,
ULNAR OSTEOTOMY,778310,CDM,360,RC,,,outpatient,,,2132,1066,,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,818.69,38.4,,654.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,818.69,38.4,,654.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1599,75,,1279.2,percent of total billed charges,75% of total billed charges for outpatient setting,1599,75,,1279.2,percent of total billed charges,75% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1599,75,,1279.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.2,35,,596.96,percent of total billed charges,35% of total billed charges for outpatient setting,1662.96,78,,1330.368,percent of total billed charges,78% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1599,75,,1279.2,percent of total billed charges,75% of total billed charges for outpatient setting,1769.56,83,,1415.648,percent of total billed charges,83% of total billed charges for outpatient setting,1066,50,,852.8,percent of total billed charges,50% of total billed charges for outpatient setting,1066,50,,852.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,835.06,39.17,,668.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,746.2,1769.56,
EXC. BILATERAL GREAT TOE NAILS,778311,CDM,360,RC,,,outpatient,,,1135,567.5,,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,435.84,38.4,,348.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,435.84,38.4,,348.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,397.25,35,,317.8,percent of total billed charges,35% of total billed charges for outpatient setting,885.3,78,,708.24,percent of total billed charges,78% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,794.5,70,,635.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,851.25,75,,681,percent of total billed charges,75% of total billed charges for outpatient setting,942.05,83,,753.64,percent of total billed charges,83% of total billed charges for outpatient setting,567.5,50,,454,percent of total billed charges,50% of total billed charges for outpatient setting,567.5,50,,454,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,444.56,39.17,,355.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,397.25,942.05,
HEMATOMA EVACUATION,778312,CDM,360,RC,,,outpatient,,,1405,702.5,,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539.52,38.4,,431.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,491.75,35,,393.4,percent of total billed charges,35% of total billed charges for outpatient setting,1095.9,78,,876.72,percent of total billed charges,78% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,983.5,70,,786.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1053.75,75,,843,percent of total billed charges,75% of total billed charges for outpatient setting,1166.15,83,,932.92,percent of total billed charges,83% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,702.5,50,,562,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,550.31,39.17,,440.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,491.75,1166.15,
INCISION SOFT TISSUE ABSCESS/D,778313,CDM,360,RC,,,outpatient,,,1498,749,,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,575.23,38.4,,460.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,575.23,38.4,,460.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,1123.5,75,,898.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.5,75,,898.8,percent of total billed charges,75% of total billed charges for outpatient setting,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,1123.5,75,,898.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,524.3,35,,419.44,percent of total billed charges,35% of total billed charges for outpatient setting,1168.44,78,,934.752,percent of total billed charges,78% of total billed charges for outpatient setting,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,1048.6,70,,838.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1123.5,75,,898.8,percent of total billed charges,75% of total billed charges for outpatient setting,1243.34,83,,994.672,percent of total billed charges,83% of total billed charges for outpatient setting,749,50,,599.2,percent of total billed charges,50% of total billed charges for outpatient setting,749,50,,599.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.73,39.17,,469.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,524.3,1243.34,
SPLIT THICKNESS SKIN GRAFT,778314,CDM,360,RC,,,outpatient,,,1604,802,,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,561.4,35,,449.12,percent of total billed charges,35% of total billed charges for outpatient setting,1251.12,78,,1000.896,percent of total billed charges,78% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1331.32,83,,1065.056,percent of total billed charges,83% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,628.26,39.17,,502.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,561.4,1331.32,
WIDE EXCISION SKIN LESION W/RE,778320,CDM,360,RC,,,outpatient,,,2296,1148,,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,803.6,35,,642.88,percent of total billed charges,35% of total billed charges for outpatient setting,1790.88,78,,1432.704,percent of total billed charges,78% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1905.68,83,,1524.544,percent of total billed charges,83% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.29,39.17,,719.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,803.6,1905.68,
PPH/ HEMORRHOIDECTOMY,778321,CDM,360,RC,,,outpatient,,,1865,932.5,,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.16,38.4,,572.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,716.16,38.4,,572.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,652.75,35,,522.2,percent of total billed charges,35% of total billed charges for outpatient setting,1454.7,78,,1163.76,percent of total billed charges,78% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1547.95,83,,1238.36,percent of total billed charges,83% of total billed charges for outpatient setting,932.5,50,,746,percent of total billed charges,50% of total billed charges for outpatient setting,932.5,50,,746,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,730.48,39.17,,584.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,652.75,1547.95,
DERMATONE BLADE,778322,CDM,270,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
ANKLE EXTERNAL FIXATOR,778323,CDM,360,RC,,,outpatient,,,3134,1567,,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1203.46,38.4,,962.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1203.46,38.4,,962.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1096.9,35,,877.52,percent of total billed charges,35% of total billed charges for outpatient setting,2444.52,78,,1955.616,percent of total billed charges,78% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,2193.8,70,,1755.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2350.5,75,,1880.4,percent of total billed charges,75% of total billed charges for outpatient setting,2601.22,83,,2080.976,percent of total billed charges,83% of total billed charges for outpatient setting,1567,50,,1253.6,percent of total billed charges,50% of total billed charges for outpatient setting,1567,50,,1253.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1227.53,39.17,,982.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1096.9,2601.22,
EXTRA LONG TRAC TUBE,778324,CDM,270,RC,,,outpatient,,,231,115.5,,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.85,35,,64.68,percent of total billed charges,35% of total billed charges for outpatient setting,180.18,78,,144.144,percent of total billed charges,78% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,191.73,83,,153.384,percent of total billed charges,83% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.47,39.17,,72.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.85,191.73,
DEBRIDEMENT WITH FLAP CLOSURE,778326,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
PERCUTANEOUS TRACH INSERTION,778327,CDM,360,RC,,,outpatient,,,1223,611.5,,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,428.05,35,,342.44,percent of total billed charges,35% of total billed charges for outpatient setting,953.94,78,,763.152,percent of total billed charges,78% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,1015.09,83,,812.072,percent of total billed charges,83% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,479.02,39.17,,383.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,428.05,1015.09,
REPAIR VENTRAL HERNIA,778328,CDM,360,RC,,,outpatient,,,1628,814,,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,625.15,38.4,,500.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,625.15,38.4,,500.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,569.8,35,,455.84,percent of total billed charges,35% of total billed charges for outpatient setting,1269.84,78,,1015.872,percent of total billed charges,78% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,1139.6,70,,911.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1221,75,,976.8,percent of total billed charges,75% of total billed charges for outpatient setting,1351.24,83,,1080.992,percent of total billed charges,83% of total billed charges for outpatient setting,814,50,,651.2,percent of total billed charges,50% of total billed charges for outpatient setting,814,50,,651.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,637.65,39.17,,510.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,569.8,1351.24,
UMBILICAL HERNIA W/CHEST WALL,778329,CDM,360,RC,,,outpatient,,,1958,979,,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,751.87,38.4,,601.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,751.87,38.4,,601.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,1468.5,75,,1174.8,percent of total billed charges,75% of total billed charges for outpatient setting,1468.5,75,,1174.8,percent of total billed charges,75% of total billed charges for outpatient setting,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,1468.5,75,,1174.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,685.3,35,,548.24,percent of total billed charges,35% of total billed charges for outpatient setting,1527.24,78,,1221.792,percent of total billed charges,78% of total billed charges for outpatient setting,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,1370.6,70,,1096.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1468.5,75,,1174.8,percent of total billed charges,75% of total billed charges for outpatient setting,1625.14,83,,1300.112,percent of total billed charges,83% of total billed charges for outpatient setting,979,50,,783.2,percent of total billed charges,50% of total billed charges for outpatient setting,979,50,,783.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,766.91,39.17,,613.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,685.3,1625.14,
PUSH 20 G-TUBE,778330,CDM,270,RC,,,outpatient,,,226,113,,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.78,38.4,,69.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.78,38.4,,69.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,169.5,75,,135.6,percent of total billed charges,75% of total billed charges for outpatient setting,169.5,75,,135.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,169.5,75,,135.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.1,35,,63.28,percent of total billed charges,35% of total billed charges for outpatient setting,176.28,78,,141.024,percent of total billed charges,78% of total billed charges for outpatient setting,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,158.2,70,,126.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.5,75,,135.6,percent of total billed charges,75% of total billed charges for outpatient setting,187.58,83,,150.064,percent of total billed charges,83% of total billed charges for outpatient setting,113,50,,90.4,percent of total billed charges,50% of total billed charges for outpatient setting,113,50,,90.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.52,39.17,,70.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,79.1,187.58,
LAP CHOLE/LAP HERNIA REPAIR,778331,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
REPAIR RECTOCELE ENTEROCELE CY,778332,CDM,360,RC,,,outpatient,,,2085,1042.5,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,729.75,35,,583.8,percent of total billed charges,35% of total billed charges for outpatient setting,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1730.55,83,,1384.44,percent of total billed charges,83% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.65,39.17,,653.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,729.75,1730.55,
EXC. PILONIDOL CYST/COLONOSCOP,778333,CDM,360,RC,,,outpatient,,,1832,916,,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,703.49,38.4,,562.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,703.49,38.4,,562.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,1374,75,,1099.2,percent of total billed charges,75% of total billed charges for outpatient setting,1374,75,,1099.2,percent of total billed charges,75% of total billed charges for outpatient setting,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,1374,75,,1099.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,641.2,35,,512.96,percent of total billed charges,35% of total billed charges for outpatient setting,1428.96,78,,1143.168,percent of total billed charges,78% of total billed charges for outpatient setting,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,1282.4,70,,1025.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1374,75,,1099.2,percent of total billed charges,75% of total billed charges for outpatient setting,1520.56,83,,1216.448,percent of total billed charges,83% of total billed charges for outpatient setting,916,50,,732.8,percent of total billed charges,50% of total billed charges for outpatient setting,916,50,,732.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,717.56,39.17,,574.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,641.2,1520.56,
DERMACARRIERS,778334,CDM,270,RC,,,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.9,61.42,
LAP HERNIA CONVERT OPEN,778335,CDM,360,RC,,,outpatient,,,6761,3380.5,,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2596.22,38.4,,2076.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2596.22,38.4,,2076.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,5070.75,75,,4056.6,percent of total billed charges,75% of total billed charges for outpatient setting,5070.75,75,,4056.6,percent of total billed charges,75% of total billed charges for outpatient setting,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,5070.75,75,,4056.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2366.35,35,,1893.08,percent of total billed charges,35% of total billed charges for outpatient setting,5273.58,78,,4218.864,percent of total billed charges,78% of total billed charges for outpatient setting,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,4732.7,70,,3786.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5070.75,75,,4056.6,percent of total billed charges,75% of total billed charges for outpatient setting,5611.63,83,,4489.304,percent of total billed charges,83% of total billed charges for outpatient setting,3380.5,50,,2704.4,percent of total billed charges,50% of total billed charges for outpatient setting,3380.5,50,,2704.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2648.14,39.17,,2118.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2366.35,5611.63,
MASTECTOMY WITH RECONSTRUCTION,778336,CDM,360,RC,,,outpatient,,,2333,1166.5,,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.55,35,,653.24,percent of total billed charges,35% of total billed charges for outpatient setting,1819.74,78,,1455.792,percent of total billed charges,78% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1936.39,83,,1549.112,percent of total billed charges,83% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.79,39.17,,731.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.55,1936.39,
SUBTOTAL BILATERAL MASTECTOMY,778337,CDM,360,RC,,,outpatient,,,2333,1166.5,,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.87,38.4,,716.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.55,35,,653.24,percent of total billed charges,35% of total billed charges for outpatient setting,1819.74,78,,1455.792,percent of total billed charges,78% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,1633.1,70,,1306.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749.75,75,,1399.8,percent of total billed charges,75% of total billed charges for outpatient setting,1936.39,83,,1549.112,percent of total billed charges,83% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,1166.5,50,,933.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.79,39.17,,731.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.55,1936.39,
EXC. BX. BREAST MASS REPAIR IN,778338,CDM,360,RC,,,outpatient,,,2191,1095.5,,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,841.34,38.4,,673.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,841.34,38.4,,673.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,1643.25,75,,1314.6,percent of total billed charges,75% of total billed charges for outpatient setting,1643.25,75,,1314.6,percent of total billed charges,75% of total billed charges for outpatient setting,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,1643.25,75,,1314.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,766.85,35,,613.48,percent of total billed charges,35% of total billed charges for outpatient setting,1708.98,78,,1367.184,percent of total billed charges,78% of total billed charges for outpatient setting,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,1533.7,70,,1226.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1643.25,75,,1314.6,percent of total billed charges,75% of total billed charges for outpatient setting,1818.53,83,,1454.824,percent of total billed charges,83% of total billed charges for outpatient setting,1095.5,50,,876.4,percent of total billed charges,50% of total billed charges for outpatient setting,1095.5,50,,876.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,858.17,39.17,,686.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,766.85,1818.53,
PPH/COLONOSCOPY PROCEDURE,778340,CDM,360,RC,,,outpatient,,,1865,932.5,,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.16,38.4,,572.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,716.16,38.4,,572.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,652.75,35,,522.2,percent of total billed charges,35% of total billed charges for outpatient setting,1454.7,78,,1163.76,percent of total billed charges,78% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305.5,70,,1044.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1398.75,75,,1119,percent of total billed charges,75% of total billed charges for outpatient setting,1547.95,83,,1238.36,percent of total billed charges,83% of total billed charges for outpatient setting,932.5,50,,746,percent of total billed charges,50% of total billed charges for outpatient setting,932.5,50,,746,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,730.48,39.17,,584.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,652.75,1547.95,
EGD/COLONOSCOPY & EXC. FOREARM,778341,CDM,360,RC,,,outpatient,,,1776,888,,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.98,38.4,,545.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,681.98,38.4,,545.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,621.6,35,,497.28,percent of total billed charges,35% of total billed charges for outpatient setting,1385.28,78,,1108.224,percent of total billed charges,78% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1474.08,83,,1179.264,percent of total billed charges,83% of total billed charges for outpatient setting,888,50,,710.4,percent of total billed charges,50% of total billed charges for outpatient setting,888,50,,710.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,695.62,39.17,,556.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,621.6,1474.08,
TRANSANAL POLYPECTOMY,778342,CDM,360,RC,,,outpatient,,,1264,632,,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.4,35,,353.92,percent of total billed charges,35% of total billed charges for outpatient setting,985.92,78,,788.736,percent of total billed charges,78% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,1049.12,83,,839.296,percent of total billed charges,83% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495.09,39.17,,396.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,442.4,1049.12,
REPAIR FLEXOR TENDON,778343,CDM,360,RC,,,outpatient,,,2310,1155,,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,887.04,38.4,,709.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,887.04,38.4,,709.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,1732.5,75,,1386,percent of total billed charges,75% of total billed charges for outpatient setting,1732.5,75,,1386,percent of total billed charges,75% of total billed charges for outpatient setting,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,1732.5,75,,1386,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.5,35,,646.8,percent of total billed charges,35% of total billed charges for outpatient setting,1801.8,78,,1441.44,percent of total billed charges,78% of total billed charges for outpatient setting,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,1617,70,,1293.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1732.5,75,,1386,percent of total billed charges,75% of total billed charges for outpatient setting,1917.3,83,,1533.84,percent of total billed charges,83% of total billed charges for outpatient setting,1155,50,,924,percent of total billed charges,50% of total billed charges for outpatient setting,1155,50,,924,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,904.78,39.17,,723.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,808.5,1917.3,
REPAIR BICEPS TENDON,778345,CDM,360,RC,,,outpatient,,,4088,2044,,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1569.79,38.4,,1255.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1569.79,38.4,,1255.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1430.8,35,,1144.64,percent of total billed charges,35% of total billed charges for outpatient setting,3188.64,78,,2550.912,percent of total billed charges,78% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,2861.6,70,,2289.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3066,75,,2452.8,percent of total billed charges,75% of total billed charges for outpatient setting,3393.04,83,,2714.432,percent of total billed charges,83% of total billed charges for outpatient setting,2044,50,,1635.2,percent of total billed charges,50% of total billed charges for outpatient setting,2044,50,,1635.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1601.19,39.17,,1280.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1430.8,3393.04,
MINOR PROC/TX,778346,CDM,360,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PELVIC EXAM,778347,CDM,360,RC,,,outpatient,,,182,91,,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.89,38.4,,55.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.89,38.4,,55.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.7,35,,50.96,percent of total billed charges,35% of total billed charges for outpatient setting,141.96,78,,113.568,percent of total billed charges,78% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,151.06,83,,120.848,percent of total billed charges,83% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.29,39.17,,57.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63.7,151.06,
DRAINAGE ABSCESS FINGER,778349,CDM,361,RC,,,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.65,35,,38.92,percent of total billed charges,35% of total billed charges for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.45,39.17,,43.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,48.65,115.37,
EXCISION NAIL & NAIL MATRIX,778350,CDM,360,RC,11750,HCPCS,outpatient,,,657,328.5,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,35,,183.96,percent of total billed charges,35% of total billed charges for outpatient setting,512.46,78,,409.968,percent of total billed charges,78% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,545.31,83,,436.248,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.34,39.17,,205.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,659,
LOW PROFILE PORT-A-CATH KIT,778352,CDM,278,RC,C1788,HCPCS,both,,,768,384,,537.6,70,,430.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,294.91,38.4,,235.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.91,38.4,,235.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,537.6,70,,430.08,percent of total billed charges,70% of billed charges for implant carveouts,537.6,70,,430.08,percent of total billed charges,70% of billed charges for implant carveouts,537.6,70,,430.08,percent of total billed charges,70% of billed charges for implant carveouts,614.4,80,,491.52,percent of total billed charges,80% of billed charges for implant carveouts,614.4,80,,491.52,percent of total billed charges,80% of billed charges for implant carveouts,537.6,70,,430.08,percent of total billed charges,70% of billed charges for implant carveouts,614.4,80,,491.52,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.8,35,,215.04,percent of total billed charges,35% of total billed charges for outpatient setting,599.04,78,,479.232,percent of total billed charges,78% of total billed charges for outpatient setting,537.6,70,,430.08,percent of total billed charges,70% of total billed charges for outpatient setting,537.6,70,,430.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,576,75,,460.8,percent of total billed charges,75% of total billed charges for outpatient setting,637.44,83,,509.952,percent of total billed charges,83% of total billed charges for outpatient setting,384,50,,307.2,percent of total billed charges,50% of total billed charges for outpatient setting,384,50,,307.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,300.81,39.17,,240.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,268.8,637.44,
TONSILECTOMY,778355,CDM,360,RC,,,outpatient,,,1544,772,,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.9,38.4,,474.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.4,35,,432.32,percent of total billed charges,35% of total billed charges for outpatient setting,1204.32,78,,963.456,percent of total billed charges,78% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,1080.8,70,,864.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1158,75,,926.4,percent of total billed charges,75% of total billed charges for outpatient setting,1281.52,83,,1025.216,percent of total billed charges,83% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,772,50,,617.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,604.76,39.17,,483.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,540.4,1281.52,
TVH AND CYSTOCELE REPAIR,778356,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
T-SLING,778357,CDM,278,RC,C1778,HCPCS,both,,,1691,845.5,,1183.7,70,,946.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,649.34,38.4,,519.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,649.34,38.4,,519.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1183.7,70,,946.96,percent of total billed charges,70% of billed charges for implant carveouts,1183.7,70,,946.96,percent of total billed charges,70% of billed charges for implant carveouts,1183.7,70,,946.96,percent of total billed charges,70% of billed charges for implant carveouts,1352.8,80,,1082.24,percent of total billed charges,80% of billed charges for implant carveouts,1352.8,80,,1082.24,percent of total billed charges,80% of billed charges for implant carveouts,1183.7,70,,946.96,percent of total billed charges,70% of billed charges for implant carveouts,1352.8,80,,1082.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,591.85,35,,473.48,percent of total billed charges,35% of total billed charges for outpatient setting,1318.98,78,,1055.184,percent of total billed charges,78% of total billed charges for outpatient setting,1183.7,70,,946.96,percent of total billed charges,70% of total billed charges for outpatient setting,1183.7,70,,946.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1268.25,75,,1014.6,percent of total billed charges,75% of total billed charges for outpatient setting,1403.53,83,,1122.824,percent of total billed charges,83% of total billed charges for outpatient setting,845.5,50,,676.4,percent of total billed charges,50% of total billed charges for outpatient setting,845.5,50,,676.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,662.33,39.17,,529.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,591.85,1403.53,
PLANTER FASCIETOMY/HEEL SPUR (,778358,CDM,360,RC,,,outpatient,,,1472,736,,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,565.25,38.4,,452.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,565.25,38.4,,452.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,1104,75,,883.2,percent of total billed charges,75% of total billed charges for outpatient setting,1104,75,,883.2,percent of total billed charges,75% of total billed charges for outpatient setting,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,1104,75,,883.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,515.2,35,,412.16,percent of total billed charges,35% of total billed charges for outpatient setting,1148.16,78,,918.528,percent of total billed charges,78% of total billed charges for outpatient setting,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,1030.4,70,,824.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1104,75,,883.2,percent of total billed charges,75% of total billed charges for outpatient setting,1221.76,83,,977.408,percent of total billed charges,83% of total billed charges for outpatient setting,736,50,,588.8,percent of total billed charges,50% of total billed charges for outpatient setting,736,50,,588.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,576.56,39.17,,461.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,515.2,1221.76,
HEEL SPUR REMOVAL (E),778359,CDM,360,RC,,,outpatient,,,1029,514.5,,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,395.14,38.4,,316.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,395.14,38.4,,316.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,360.15,35,,288.12,percent of total billed charges,35% of total billed charges for outpatient setting,802.62,78,,642.096,percent of total billed charges,78% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,854.07,83,,683.256,percent of total billed charges,83% of total billed charges for outpatient setting,514.5,50,,411.6,percent of total billed charges,50% of total billed charges for outpatient setting,514.5,50,,411.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,403.04,39.17,,322.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,360.15,854.07,
CYSTOCELE/RECTOCELE REPAIR,778360,CDM,360,RC,,,outpatient,,,2021,1010.5,,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,776.06,38.4,,620.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,707.35,35,,565.88,percent of total billed charges,35% of total billed charges for outpatient setting,1576.38,78,,1261.104,percent of total billed charges,78% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,1414.7,70,,1131.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1515.75,75,,1212.6,percent of total billed charges,75% of total billed charges for outpatient setting,1677.43,83,,1341.944,percent of total billed charges,83% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,1010.5,50,,808.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,791.58,39.17,,633.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,707.35,1677.43,
PANNICULECTOMY,778361,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
EXC GANGLION CYST & EXC OF LIP,778362,CDM,360,RC,,,outpatient,,,2042,1021,,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,784.13,38.4,,627.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,784.13,38.4,,627.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,1531.5,75,,1225.2,percent of total billed charges,75% of total billed charges for outpatient setting,1531.5,75,,1225.2,percent of total billed charges,75% of total billed charges for outpatient setting,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,1531.5,75,,1225.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,714.7,35,,571.76,percent of total billed charges,35% of total billed charges for outpatient setting,1592.76,78,,1274.208,percent of total billed charges,78% of total billed charges for outpatient setting,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,1429.4,70,,1143.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1531.5,75,,1225.2,percent of total billed charges,75% of total billed charges for outpatient setting,1694.86,83,,1355.888,percent of total billed charges,83% of total billed charges for outpatient setting,1021,50,,816.8,percent of total billed charges,50% of total billed charges for outpatient setting,1021,50,,816.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,799.81,39.17,,639.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,714.7,1694.86,
FOREIGN BODY RETRIEVE NET,778363,CDM,270,RC,,,outpatient,,,556,278,,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.6,35,,155.68,percent of total billed charges,35% of total billed charges for outpatient setting,433.68,78,,346.944,percent of total billed charges,78% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,461.48,83,,369.184,percent of total billed charges,83% of total billed charges for outpatient setting,278,50,,222.4,percent of total billed charges,50% of total billed charges for outpatient setting,278,50,,222.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.77,39.17,,174.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,194.6,461.48,
REPAIR TRAUMATIC LACERATION &,778365,CDM,360,RC,,,outpatient,,,1374,687,,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,480.9,35,,384.72,percent of total billed charges,35% of total billed charges for outpatient setting,1071.72,78,,857.376,percent of total billed charges,78% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1140.42,83,,912.336,percent of total billed charges,83% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,538.17,39.17,,430.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,480.9,1140.42,
ABD HYST W/LOWER ANTERIOR RESE,778366,CDM,360,RC,,,outpatient,,,1999,999.5,,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,767.62,38.4,,614.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,767.62,38.4,,614.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,1499.25,75,,1199.4,percent of total billed charges,75% of total billed charges for outpatient setting,1499.25,75,,1199.4,percent of total billed charges,75% of total billed charges for outpatient setting,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,1499.25,75,,1199.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,699.65,35,,559.72,percent of total billed charges,35% of total billed charges for outpatient setting,1559.22,78,,1247.376,percent of total billed charges,78% of total billed charges for outpatient setting,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,1399.3,70,,1119.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1499.25,75,,1199.4,percent of total billed charges,75% of total billed charges for outpatient setting,1659.17,83,,1327.336,percent of total billed charges,83% of total billed charges for outpatient setting,999.5,50,,799.6,percent of total billed charges,50% of total billed charges for outpatient setting,999.5,50,,799.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,782.97,39.17,,626.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,699.65,1659.17,
STAPLER - 28MM CEEA PREMIUM,778367,CDM,270,RC,,,outpatient,,,479,239.5,,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.94,38.4,,147.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.94,38.4,,147.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,359.25,75,,287.4,percent of total billed charges,75% of total billed charges for outpatient setting,359.25,75,,287.4,percent of total billed charges,75% of total billed charges for outpatient setting,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,359.25,75,,287.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,167.65,35,,134.12,percent of total billed charges,35% of total billed charges for outpatient setting,373.62,78,,298.896,percent of total billed charges,78% of total billed charges for outpatient setting,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,335.3,70,,268.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,359.25,75,,287.4,percent of total billed charges,75% of total billed charges for outpatient setting,397.57,83,,318.056,percent of total billed charges,83% of total billed charges for outpatient setting,239.5,50,,191.6,percent of total billed charges,50% of total billed charges for outpatient setting,239.5,50,,191.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.62,39.17,,150.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,167.65,397.57,
BILATERAL AXILLARY LIPECTOMY,778368,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
KNEE ARTHROSCOPY WITH ORIF,778370,CDM,360,RC,,,outpatient,,,5638,2819,,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2164.99,38.4,,1731.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2164.99,38.4,,1731.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,4228.5,75,,3382.8,percent of total billed charges,75% of total billed charges for outpatient setting,4228.5,75,,3382.8,percent of total billed charges,75% of total billed charges for outpatient setting,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,4228.5,75,,3382.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1973.3,35,,1578.64,percent of total billed charges,35% of total billed charges for outpatient setting,4397.64,78,,3518.112,percent of total billed charges,78% of total billed charges for outpatient setting,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,3946.6,70,,3157.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4228.5,75,,3382.8,percent of total billed charges,75% of total billed charges for outpatient setting,4679.54,83,,3743.632,percent of total billed charges,83% of total billed charges for outpatient setting,2819,50,,2255.2,percent of total billed charges,50% of total billed charges for outpatient setting,2819,50,,2255.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2208.29,39.17,,1766.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1973.3,4679.54,
RECONSTRUCTION FOOT,778371,CDM,360,RC,,,outpatient,,,1604,802,,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,615.94,38.4,,492.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,561.4,35,,449.12,percent of total billed charges,35% of total billed charges for outpatient setting,1251.12,78,,1000.896,percent of total billed charges,78% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,1122.8,70,,898.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1203,75,,962.4,percent of total billed charges,75% of total billed charges for outpatient setting,1331.32,83,,1065.056,percent of total billed charges,83% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,802,50,,641.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,628.26,39.17,,502.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,561.4,1331.32,
STIMUPLEX NEEDLE,778372,CDM,270,RC,,,outpatient,,,125,62.5,,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.75,35,,35,percent of total billed charges,35% of total billed charges for outpatient setting,97.5,78,,78,percent of total billed charges,78% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,103.75,83,,83,percent of total billed charges,83% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.96,39.17,,39.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.75,103.75,
TRAY - BLUE RHINO TRACH,778373,CDM,270,RC,,,outpatient,,,392,196,,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.2,35,,109.76,percent of total billed charges,35% of total billed charges for outpatient setting,305.76,78,,244.608,percent of total billed charges,78% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,325.36,83,,260.288,percent of total billed charges,83% of total billed charges for outpatient setting,196,50,,156.8,percent of total billed charges,50% of total billed charges for outpatient setting,196,50,,156.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153.54,39.17,,122.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,137.2,325.36,
LONG LEG CAST,778374,CDM,360,RC,,,outpatient,,,204,102,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.34,38.4,,62.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.34,38.4,,62.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.4,35,,57.12,percent of total billed charges,35% of total billed charges for outpatient setting,159.12,78,,127.296,percent of total billed charges,78% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,169.32,83,,135.456,percent of total billed charges,83% of total billed charges for outpatient setting,102,50,,81.6,percent of total billed charges,50% of total billed charges for outpatient setting,102,50,,81.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.91,39.17,,63.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,71.4,169.32,
REPAIR WOUND/LESION EYE LIP NO,778375,CDM,360,RC,,,outpatient,,,488,244,,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.39,38.4,,149.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.39,38.4,,149.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,366,75,,292.8,percent of total billed charges,75% of total billed charges for outpatient setting,366,75,,292.8,percent of total billed charges,75% of total billed charges for outpatient setting,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,366,75,,292.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.8,35,,136.64,percent of total billed charges,35% of total billed charges for outpatient setting,380.64,78,,304.512,percent of total billed charges,78% of total billed charges for outpatient setting,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,341.6,70,,273.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,366,75,,292.8,percent of total billed charges,75% of total billed charges for outpatient setting,405.04,83,,324.032,percent of total billed charges,83% of total billed charges for outpatient setting,244,50,,195.2,percent of total billed charges,50% of total billed charges for outpatient setting,244,50,,195.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,191.14,39.17,,152.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,170.8,405.04,
EMBOLECTOMY,778378,CDM,360,RC,,,outpatient,,,2296,1148,,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,881.66,38.4,,705.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,803.6,35,,642.88,percent of total billed charges,35% of total billed charges for outpatient setting,1790.88,78,,1432.704,percent of total billed charges,78% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,1607.2,70,,1285.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722,75,,1377.6,percent of total billed charges,75% of total billed charges for outpatient setting,1905.68,83,,1524.544,percent of total billed charges,83% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,1148,50,,918.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.29,39.17,,719.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,803.6,1905.68,
REMOVAL OF CONDYLOMA,778379,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
CAST SYN SH ARM CHILD,778382,CDM,270,RC,,,outpatient,,,230,115,,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.32,38.4,,70.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.5,35,,64.4,percent of total billed charges,35% of total billed charges for outpatient setting,179.4,78,,143.52,percent of total billed charges,78% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,161,70,,128.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.5,75,,138,percent of total billed charges,75% of total billed charges for outpatient setting,190.9,83,,152.72,percent of total billed charges,83% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,115,50,,92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.09,39.17,,72.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.5,190.9,
RETRIEVAL ROTH NET,778384,CDM,270,RC,,,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.9,35,,54.32,percent of total billed charges,35% of total billed charges for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.99,39.17,,60.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.9,161.02,
HYSTERSCOPY/ESSURE PLACEMENT,778386,CDM,360,RC,,,outpatient,,,1895,947.5,,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,727.68,38.4,,582.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,727.68,38.4,,582.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.25,35,,530.6,percent of total billed charges,35% of total billed charges for outpatient setting,1478.1,78,,1182.48,percent of total billed charges,78% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,1326.5,70,,1061.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1421.25,75,,1137,percent of total billed charges,75% of total billed charges for outpatient setting,1572.85,83,,1258.28,percent of total billed charges,83% of total billed charges for outpatient setting,947.5,50,,758,percent of total billed charges,50% of total billed charges for outpatient setting,947.5,50,,758,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,742.23,39.17,,593.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,663.25,1572.85,
COLONOSCOPY W/HEMORRHOID BANDI,778388,CDM,360,RC,,,outpatient,,,1223,611.5,,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,469.63,38.4,,375.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,428.05,35,,342.44,percent of total billed charges,35% of total billed charges for outpatient setting,953.94,78,,763.152,percent of total billed charges,78% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,856.1,70,,684.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.25,75,,733.8,percent of total billed charges,75% of total billed charges for outpatient setting,1015.09,83,,812.072,percent of total billed charges,83% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,611.5,50,,489.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,479.02,39.17,,383.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,428.05,1015.09,
GUIDE WIRE (COOK),778389,CDM,270,RC,,,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,60.55,143.59,
JEJUNOSTOMY TUBE,778390,CDM,270,RC,,,outpatient,,,248,124,,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.23,38.4,,76.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.23,38.4,,76.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.8,35,,69.44,percent of total billed charges,35% of total billed charges for outpatient setting,193.44,78,,154.752,percent of total billed charges,78% of total billed charges for outpatient setting,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,173.6,70,,138.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,205.84,83,,164.672,percent of total billed charges,83% of total billed charges for outpatient setting,124,50,,99.2,percent of total billed charges,50% of total billed charges for outpatient setting,124,50,,99.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.13,39.17,,77.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.8,205.84,
CHANGE J-TUBE,778391,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
AMERICAN CATHETER,778392,CDM,270,RC,,,outpatient,,,253,126.5,,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.15,38.4,,77.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.15,38.4,,77.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.55,35,,70.84,percent of total billed charges,35% of total billed charges for outpatient setting,197.34,78,,157.872,percent of total billed charges,78% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,209.99,83,,167.992,percent of total billed charges,83% of total billed charges for outpatient setting,126.5,50,,101.2,percent of total billed charges,50% of total billed charges for outpatient setting,126.5,50,,101.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.09,39.17,,79.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,88.55,209.99,
LAVH CONVERT OPEN,778395,CDM,360,RC,,,outpatient,,,5754,2877,,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2209.54,38.4,,1767.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2209.54,38.4,,1767.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2013.9,35,,1611.12,percent of total billed charges,35% of total billed charges for outpatient setting,4488.12,78,,3590.496,percent of total billed charges,78% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,4027.8,70,,3222.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4315.5,75,,3452.4,percent of total billed charges,75% of total billed charges for outpatient setting,4775.82,83,,3820.656,percent of total billed charges,83% of total billed charges for outpatient setting,2877,50,,2301.6,percent of total billed charges,50% of total billed charges for outpatient setting,2877,50,,2301.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2253.73,39.17,,1802.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2013.9,4775.82,
SMALL JOINT IMPLANT PROCEDURE,778396,CDM,360,RC,,,outpatient,,,2231,1115.5,,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,856.7,38.4,,685.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,856.7,38.4,,685.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,1673.25,75,,1338.6,percent of total billed charges,75% of total billed charges for outpatient setting,1673.25,75,,1338.6,percent of total billed charges,75% of total billed charges for outpatient setting,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,1673.25,75,,1338.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,780.85,35,,624.68,percent of total billed charges,35% of total billed charges for outpatient setting,1740.18,78,,1392.144,percent of total billed charges,78% of total billed charges for outpatient setting,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,1561.7,70,,1249.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1673.25,75,,1338.6,percent of total billed charges,75% of total billed charges for outpatient setting,1851.73,83,,1481.384,percent of total billed charges,83% of total billed charges for outpatient setting,1115.5,50,,892.4,percent of total billed charges,50% of total billed charges for outpatient setting,1115.5,50,,892.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,873.83,39.17,,699.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,780.85,1851.73,
D&C/CYSTOSCOPY,778397,CDM,360,RC,,,outpatient,,,1888,944,,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,724.99,38.4,,579.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,724.99,38.4,,579.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,1416,75,,1132.8,percent of total billed charges,75% of total billed charges for outpatient setting,1416,75,,1132.8,percent of total billed charges,75% of total billed charges for outpatient setting,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,1416,75,,1132.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,660.8,35,,528.64,percent of total billed charges,35% of total billed charges for outpatient setting,1472.64,78,,1178.112,percent of total billed charges,78% of total billed charges for outpatient setting,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,1321.6,70,,1057.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1416,75,,1132.8,percent of total billed charges,75% of total billed charges for outpatient setting,1567.04,83,,1253.632,percent of total billed charges,83% of total billed charges for outpatient setting,944,50,,755.2,percent of total billed charges,50% of total billed charges for outpatient setting,944,50,,755.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,739.49,39.17,,591.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,660.8,1567.04,
RELEASE DEQUERVAINS,778399,CDM,360,RC,,,outpatient,,,5180,2590,,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1989.12,38.4,,1591.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1989.12,38.4,,1591.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,3885,75,,3108,percent of total billed charges,75% of total billed charges for outpatient setting,3885,75,,3108,percent of total billed charges,75% of total billed charges for outpatient setting,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,3885,75,,3108,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1813,35,,1450.4,percent of total billed charges,35% of total billed charges for outpatient setting,4040.4,78,,3232.32,percent of total billed charges,78% of total billed charges for outpatient setting,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,3626,70,,2900.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3885,75,,3108,percent of total billed charges,75% of total billed charges for outpatient setting,4299.4,83,,3439.52,percent of total billed charges,83% of total billed charges for outpatient setting,2590,50,,2072,percent of total billed charges,50% of total billed charges for outpatient setting,2590,50,,2072,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2028.9,39.17,,1623.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1813,4299.4,
COLONOSCOPY W/ABLATION,778403,CDM,360,RC,,,outpatient,,,1468,734,,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,563.71,38.4,,450.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,563.71,38.4,,450.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,1101,75,,880.8,percent of total billed charges,75% of total billed charges for outpatient setting,1101,75,,880.8,percent of total billed charges,75% of total billed charges for outpatient setting,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,1101,75,,880.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,513.8,35,,411.04,percent of total billed charges,35% of total billed charges for outpatient setting,1145.04,78,,916.032,percent of total billed charges,78% of total billed charges for outpatient setting,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,1027.6,70,,822.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1101,75,,880.8,percent of total billed charges,75% of total billed charges for outpatient setting,1218.44,83,,974.752,percent of total billed charges,83% of total billed charges for outpatient setting,734,50,,587.2,percent of total billed charges,50% of total billed charges for outpatient setting,734,50,,587.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,574.98,39.17,,459.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,513.8,1218.44,
COLONOSCOPY/POLYP W/HEMORRHOID,778405,CDM,360,RC,,,outpatient,,,1590,795,,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,610.56,38.4,,488.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,610.56,38.4,,488.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,1192.5,75,,954,percent of total billed charges,75% of total billed charges for outpatient setting,1192.5,75,,954,percent of total billed charges,75% of total billed charges for outpatient setting,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,1192.5,75,,954,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,556.5,35,,445.2,percent of total billed charges,35% of total billed charges for outpatient setting,1240.2,78,,992.16,percent of total billed charges,78% of total billed charges for outpatient setting,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,1113,70,,890.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1192.5,75,,954,percent of total billed charges,75% of total billed charges for outpatient setting,1319.7,83,,1055.76,percent of total billed charges,83% of total billed charges for outpatient setting,795,50,,636,percent of total billed charges,50% of total billed charges for outpatient setting,795,50,,636,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,622.77,39.17,,498.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,556.5,1319.7,
DEBRIDE & REVISION OF DEEP LAC,778406,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
PULL 20 FR PEG TUBE,778407,CDM,270,RC,,,outpatient,,,200,100,,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70,35,,56,percent of total billed charges,35% of total billed charges for outpatient setting,156,78,,124.8,percent of total billed charges,78% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,166,83,,132.8,percent of total billed charges,83% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.34,39.17,,62.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70,166,
PEANUT SPONGE,778408,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
LAP APPY CONVERT OPEN,778409,CDM,360,RC,,,outpatient,,,3092,1546,,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1187.33,38.4,,949.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1187.33,38.4,,949.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,2319,75,,1855.2,percent of total billed charges,75% of total billed charges for outpatient setting,2319,75,,1855.2,percent of total billed charges,75% of total billed charges for outpatient setting,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,2319,75,,1855.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1082.2,35,,865.76,percent of total billed charges,35% of total billed charges for outpatient setting,2411.76,78,,1929.408,percent of total billed charges,78% of total billed charges for outpatient setting,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,2164.4,70,,1731.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2319,75,,1855.2,percent of total billed charges,75% of total billed charges for outpatient setting,2566.36,83,,2053.088,percent of total billed charges,83% of total billed charges for outpatient setting,1546,50,,1236.8,percent of total billed charges,50% of total billed charges for outpatient setting,1546,50,,1236.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1211.08,39.17,,968.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1082.2,2566.36,
BASKET -3FR HELICAL STONE,778410,CDM,270,RC,,,outpatient,,,386,193,,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.22,38.4,,118.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.22,38.4,,118.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.1,35,,108.08,percent of total billed charges,35% of total billed charges for outpatient setting,301.08,78,,240.864,percent of total billed charges,78% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,320.38,83,,256.304,percent of total billed charges,83% of total billed charges for outpatient setting,193,50,,154.4,percent of total billed charges,50% of total billed charges for outpatient setting,193,50,,154.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.18,39.17,,120.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,135.1,320.38,
EGD/COLONOSCOPY W/HEMORRHOID B,778412,CDM,360,RC,,,outpatient,,,2475,1237.5,,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,950.4,38.4,,760.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,950.4,38.4,,760.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,1856.25,75,,1485,percent of total billed charges,75% of total billed charges for outpatient setting,1856.25,75,,1485,percent of total billed charges,75% of total billed charges for outpatient setting,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,1856.25,75,,1485,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,866.25,35,,693,percent of total billed charges,35% of total billed charges for outpatient setting,1930.5,78,,1544.4,percent of total billed charges,78% of total billed charges for outpatient setting,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,1732.5,70,,1386,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1856.25,75,,1485,percent of total billed charges,75% of total billed charges for outpatient setting,2054.25,83,,1643.4,percent of total billed charges,83% of total billed charges for outpatient setting,1237.5,50,,990,percent of total billed charges,50% of total billed charges for outpatient setting,1237.5,50,,990,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,969.41,39.17,,775.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,866.25,2054.25,
LAP CHOLE W/BTL,778413,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
LIGATION INTERNAL HEMORRHOIDS,778414,CDM,360,RC,,,outpatient,,,1264,632,,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,485.38,38.4,,388.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.4,35,,353.92,percent of total billed charges,35% of total billed charges for outpatient setting,985.92,78,,788.736,percent of total billed charges,78% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,884.8,70,,707.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,948,75,,758.4,percent of total billed charges,75% of total billed charges for outpatient setting,1049.12,83,,839.296,percent of total billed charges,83% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,632,50,,505.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495.09,39.17,,396.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,442.4,1049.12,
COLONOSCOPY W MULTIPLE POLPY &,778415,CDM,360,RC,,,outpatient,,,1651,825.5,,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,633.98,38.4,,507.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,633.98,38.4,,507.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,1238.25,75,,990.6,percent of total billed charges,75% of total billed charges for outpatient setting,1238.25,75,,990.6,percent of total billed charges,75% of total billed charges for outpatient setting,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,1238.25,75,,990.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.85,35,,462.28,percent of total billed charges,35% of total billed charges for outpatient setting,1287.78,78,,1030.224,percent of total billed charges,78% of total billed charges for outpatient setting,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,1155.7,70,,924.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1238.25,75,,990.6,percent of total billed charges,75% of total billed charges for outpatient setting,1370.33,83,,1096.264,percent of total billed charges,83% of total billed charges for outpatient setting,825.5,50,,660.4,percent of total billed charges,50% of total billed charges for outpatient setting,825.5,50,,660.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,646.66,39.17,,517.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,577.85,1370.33,
D & C W/POSTERIA REPAIR,778416,CDM,360,RC,,,outpatient,,,2085,1042.5,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,729.75,35,,583.8,percent of total billed charges,35% of total billed charges for outpatient setting,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1730.55,83,,1384.44,percent of total billed charges,83% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.65,39.17,,653.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,729.75,1730.55,
HARMONIC SCALPEL SHEAR,778417,CDM,270,RC,,,outpatient,,,466,233,,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.1,35,,130.48,percent of total billed charges,35% of total billed charges for outpatient setting,363.48,78,,290.784,percent of total billed charges,78% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,386.78,83,,309.424,percent of total billed charges,83% of total billed charges for outpatient setting,233,50,,186.4,percent of total billed charges,50% of total billed charges for outpatient setting,233,50,,186.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.52,39.17,,146.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,163.1,386.78,
REPLACE G-TUBE,778419,CDM,360,RC,43246,HCPCS,outpatient,,,1043,521.5,,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,400.51,38.4,,320.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400.51,38.4,,320.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.05,35,,292.04,percent of total billed charges,35% of total billed charges for outpatient setting,813.54,78,,650.832,percent of total billed charges,78% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,865.69,83,,692.552,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.52,39.17,,326.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.05,2175,
MESH - PROLENE 3X5,778420,CDM,278,RC,C1781,HCPCS,both,,,186,93,,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.1,35,,52.08,percent of total billed charges,35% of total billed charges for outpatient setting,145.08,78,,116.064,percent of total billed charges,78% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.38,83,,123.504,percent of total billed charges,83% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.85,39.17,,58.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,65.1,186,
REMOVAL EXOSTOSIS BILATERAL FE,778421,CDM,360,RC,,,outpatient,,,1360,680,,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,522.24,38.4,,417.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,522.24,38.4,,417.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,1020,75,,816,percent of total billed charges,75% of total billed charges for outpatient setting,1020,75,,816,percent of total billed charges,75% of total billed charges for outpatient setting,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,1020,75,,816,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,476,35,,380.8,percent of total billed charges,35% of total billed charges for outpatient setting,1060.8,78,,848.64,percent of total billed charges,78% of total billed charges for outpatient setting,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,952,70,,761.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1020,75,,816,percent of total billed charges,75% of total billed charges for outpatient setting,1128.8,83,,903.04,percent of total billed charges,83% of total billed charges for outpatient setting,680,50,,544,percent of total billed charges,50% of total billed charges for outpatient setting,680,50,,544,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,532.68,39.17,,426.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,476,1128.8,
REPAIR AV GRAFT,778422,CDM,360,RC,,,outpatient,,,1374,687,,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,480.9,35,,384.72,percent of total billed charges,35% of total billed charges for outpatient setting,1071.72,78,,857.376,percent of total billed charges,78% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1140.42,83,,912.336,percent of total billed charges,83% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,538.17,39.17,,430.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,480.9,1140.42,
DIAG LAP/SX D&C W/BTL,778423,CDM,360,RC,,,outpatient,,,4425,2212.5,,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1699.2,38.4,,1359.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1699.2,38.4,,1359.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,35,,1239,percent of total billed charges,35% of total billed charges for outpatient setting,3451.5,78,,2761.2,percent of total billed charges,78% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,3097.5,70,,2478,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3318.75,75,,2655,percent of total billed charges,75% of total billed charges for outpatient setting,3672.75,83,,2938.2,percent of total billed charges,83% of total billed charges for outpatient setting,2212.5,50,,1770,percent of total billed charges,50% of total billed charges for outpatient setting,2212.5,50,,1770,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1733.18,39.17,,1386.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1548.75,3672.75,
EXP LAP/TAH/COLON RESECTION,778424,CDM,360,RC,,,outpatient,,,3151,1575.5,,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1102.85,35,,882.28,percent of total billed charges,35% of total billed charges for outpatient setting,2457.78,78,,1966.224,percent of total billed charges,78% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2615.33,83,,2092.264,percent of total billed charges,83% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1234.18,39.17,,987.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1102.85,2615.33,
LAPAROSCOPY,778425,CDM,360,RC,,,outpatient,,,3799,1899.5,,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1458.82,38.4,,1167.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1458.82,38.4,,1167.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,2849.25,75,,2279.4,percent of total billed charges,75% of total billed charges for outpatient setting,2849.25,75,,2279.4,percent of total billed charges,75% of total billed charges for outpatient setting,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,2849.25,75,,2279.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1329.65,35,,1063.72,percent of total billed charges,35% of total billed charges for outpatient setting,2963.22,78,,2370.576,percent of total billed charges,78% of total billed charges for outpatient setting,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,2659.3,70,,2127.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2849.25,75,,2279.4,percent of total billed charges,75% of total billed charges for outpatient setting,3153.17,83,,2522.536,percent of total billed charges,83% of total billed charges for outpatient setting,1899.5,50,,1519.6,percent of total billed charges,50% of total billed charges for outpatient setting,1899.5,50,,1519.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1488,39.17,,1190.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1329.65,3153.17,
DILITATION & CURRETAGE,778426,CDM,360,RC,,,outpatient,,,349,174.5,,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.02,38.4,,107.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.02,38.4,,107.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.15,35,,97.72,percent of total billed charges,35% of total billed charges for outpatient setting,272.22,78,,217.776,percent of total billed charges,78% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,289.67,83,,231.736,percent of total billed charges,83% of total billed charges for outpatient setting,174.5,50,,139.6,percent of total billed charges,50% of total billed charges for outpatient setting,174.5,50,,139.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.7,39.17,,109.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.15,289.67,
TUBAL,778427,CDM,360,RC,,,outpatient,,,278,139,,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.3,35,,77.84,percent of total billed charges,35% of total billed charges for outpatient setting,216.84,78,,173.472,percent of total billed charges,78% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,230.74,83,,184.592,percent of total billed charges,83% of total billed charges for outpatient setting,139,50,,111.2,percent of total billed charges,50% of total billed charges for outpatient setting,139,50,,111.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.89,39.17,,87.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,97.3,230.74,
HARMONIC WAVE COAG SHEARS,778428,CDM,270,RC,,,outpatient,,,584,292,,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.4,35,,163.52,percent of total billed charges,35% of total billed charges for outpatient setting,455.52,78,,364.416,percent of total billed charges,78% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,484.72,83,,387.776,percent of total billed charges,83% of total billed charges for outpatient setting,292,50,,233.6,percent of total billed charges,50% of total billed charges for outpatient setting,292,50,,233.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.75,39.17,,183,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,204.4,484.72,
HAND ASSISTED LAP COLECTOMY CO,778429,CDM,360,RC,,,outpatient,,,5557,2778.5,,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2133.89,38.4,,1707.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2133.89,38.4,,1707.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,4167.75,75,,3334.2,percent of total billed charges,75% of total billed charges for outpatient setting,4167.75,75,,3334.2,percent of total billed charges,75% of total billed charges for outpatient setting,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,4167.75,75,,3334.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1944.95,35,,1555.96,percent of total billed charges,35% of total billed charges for outpatient setting,4334.46,78,,3467.568,percent of total billed charges,78% of total billed charges for outpatient setting,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,3889.9,70,,3111.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4167.75,75,,3334.2,percent of total billed charges,75% of total billed charges for outpatient setting,4612.31,83,,3689.848,percent of total billed charges,83% of total billed charges for outpatient setting,2778.5,50,,2222.8,percent of total billed charges,50% of total billed charges for outpatient setting,2778.5,50,,2222.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2176.57,39.17,,1741.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1944.95,4612.31,
PIP JOINT FUSION,778431,CDM,360,RC,,,outpatient,,,2962,1481,,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1137.41,38.4,,909.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1137.41,38.4,,909.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1036.7,35,,829.36,percent of total billed charges,35% of total billed charges for outpatient setting,2310.36,78,,1848.288,percent of total billed charges,78% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,2073.4,70,,1658.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2221.5,75,,1777.2,percent of total billed charges,75% of total billed charges for outpatient setting,2458.46,83,,1966.768,percent of total billed charges,83% of total billed charges for outpatient setting,1481,50,,1184.8,percent of total billed charges,50% of total billed charges for outpatient setting,1481,50,,1184.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1160.16,39.17,,928.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1036.7,2458.46,
BRONCHOSCOPY/BILAT SPHINCTEROT,778432,CDM,360,RC,,,outpatient,,,2479,1239.5,,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,951.94,38.4,,761.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,951.94,38.4,,761.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,1859.25,75,,1487.4,percent of total billed charges,75% of total billed charges for outpatient setting,1859.25,75,,1487.4,percent of total billed charges,75% of total billed charges for outpatient setting,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,1859.25,75,,1487.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,867.65,35,,694.12,percent of total billed charges,35% of total billed charges for outpatient setting,1933.62,78,,1546.896,percent of total billed charges,78% of total billed charges for outpatient setting,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,1735.3,70,,1388.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1859.25,75,,1487.4,percent of total billed charges,75% of total billed charges for outpatient setting,2057.57,83,,1646.056,percent of total billed charges,83% of total billed charges for outpatient setting,1239.5,50,,991.6,percent of total billed charges,50% of total billed charges for outpatient setting,1239.5,50,,991.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,970.98,39.17,,776.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,867.65,2057.57,
AXILLARY NODE DISECTION,778433,CDM,360,RC,,,outpatient,,,1378,689,,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,529.15,38.4,,423.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,529.15,38.4,,423.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,482.3,35,,385.84,percent of total billed charges,35% of total billed charges for outpatient setting,1074.84,78,,859.872,percent of total billed charges,78% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,1143.74,83,,914.992,percent of total billed charges,83% of total billed charges for outpatient setting,689,50,,551.2,percent of total billed charges,50% of total billed charges for outpatient setting,689,50,,551.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.73,39.17,,431.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,482.3,1143.74,
LOWER ANTERIOR RESECTION,778434,CDM,360,RC,,,outpatient,,,3151,1575.5,,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1209.98,38.4,,967.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1102.85,35,,882.28,percent of total billed charges,35% of total billed charges for outpatient setting,2457.78,78,,1966.224,percent of total billed charges,78% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,2205.7,70,,1764.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2363.25,75,,1890.6,percent of total billed charges,75% of total billed charges for outpatient setting,2615.33,83,,2092.264,percent of total billed charges,83% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,1575.5,50,,1260.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1234.18,39.17,,987.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1102.85,2615.33,
SPLEENECTOMY,778435,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
ULTRAFOAM 3 1/8  X 2.5,778436,CDM,270,RC,,,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28.7,68.06,
ULTRAFOAM 3 1/8  X 5,778437,CDM,270,RC,,,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.4,35,,29.12,percent of total billed charges,35% of total billed charges for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.74,39.17,,32.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.4,86.32,
DRAIN FLUTED W/TROCAR,778438,CDM,270,RC,,,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
EGD POST BRONCH,778439,CDM,360,RC,,,outpatient,,,1193,596.5,,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,458.11,38.4,,366.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458.11,38.4,,366.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,894.75,75,,715.8,percent of total billed charges,75% of total billed charges for outpatient setting,894.75,75,,715.8,percent of total billed charges,75% of total billed charges for outpatient setting,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,894.75,75,,715.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417.55,35,,334.04,percent of total billed charges,35% of total billed charges for outpatient setting,930.54,78,,744.432,percent of total billed charges,78% of total billed charges for outpatient setting,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,835.1,70,,668.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,894.75,75,,715.8,percent of total billed charges,75% of total billed charges for outpatient setting,990.19,83,,792.152,percent of total billed charges,83% of total billed charges for outpatient setting,596.5,50,,477.2,percent of total billed charges,50% of total billed charges for outpatient setting,596.5,50,,477.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,467.27,39.17,,373.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,417.55,990.19,
LARYNGOSCOPY,778440,CDM,360,RC,,,outpatient,,,1579,789.5,,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,606.34,38.4,,485.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,606.34,38.4,,485.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,1184.25,75,,947.4,percent of total billed charges,75% of total billed charges for outpatient setting,1184.25,75,,947.4,percent of total billed charges,75% of total billed charges for outpatient setting,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,1184.25,75,,947.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,552.65,35,,442.12,percent of total billed charges,35% of total billed charges for outpatient setting,1231.62,78,,985.296,percent of total billed charges,78% of total billed charges for outpatient setting,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,1105.3,70,,884.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1184.25,75,,947.4,percent of total billed charges,75% of total billed charges for outpatient setting,1310.57,83,,1048.456,percent of total billed charges,83% of total billed charges for outpatient setting,789.5,50,,631.6,percent of total billed charges,50% of total billed charges for outpatient setting,789.5,50,,631.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,618.47,39.17,,494.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,552.65,1310.57,
BALLOON DILITATION CATH(MAX FO,778441,CDM,270,RC,,,outpatient,,,287,143.5,,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.45,35,,80.36,percent of total billed charges,35% of total billed charges for outpatient setting,223.86,78,,179.088,percent of total billed charges,78% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,238.21,83,,190.568,percent of total billed charges,83% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.41,39.17,,89.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,100.45,238.21,
PYLOROPLASTY/VAGOTOMY,778442,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
D&C WITH ENDOMETRIAL ABLASION,778443,CDM,360,RC,,,outpatient,,,2908,1454,,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1116.67,38.4,,893.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1116.67,38.4,,893.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1017.8,35,,814.24,percent of total billed charges,35% of total billed charges for outpatient setting,2268.24,78,,1814.592,percent of total billed charges,78% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2413.64,83,,1930.912,percent of total billed charges,83% of total billed charges for outpatient setting,1454,50,,1163.2,percent of total billed charges,50% of total billed charges for outpatient setting,1454,50,,1163.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1139,39.17,,911.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1017.8,2413.64,
SNARE - SD-23 OU-20 SPIRAL,778444,CDM,270,RC,,,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,64.74,
PAP SMEAR & EXAM UNDER ANEST,778445,CDM,360,RC,,,outpatient,,,717,358.5,,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,275.33,38.4,,220.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.95,35,,200.76,percent of total billed charges,35% of total billed charges for outpatient setting,559.26,78,,447.408,percent of total billed charges,78% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,501.9,70,,401.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,537.75,75,,430.2,percent of total billed charges,75% of total billed charges for outpatient setting,595.11,83,,476.088,percent of total billed charges,83% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,358.5,50,,286.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,280.84,39.17,,224.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,250.95,595.11,
FLEX SIG,778446,CDM,360,RC,,,outpatient,,,612,306,,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.01,38.4,,188.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,235.01,38.4,,188.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,459,75,,367.2,percent of total billed charges,75% of total billed charges for outpatient setting,459,75,,367.2,percent of total billed charges,75% of total billed charges for outpatient setting,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,459,75,,367.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,214.2,35,,171.36,percent of total billed charges,35% of total billed charges for outpatient setting,477.36,78,,381.888,percent of total billed charges,78% of total billed charges for outpatient setting,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,428.4,70,,342.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,459,75,,367.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.96,83,,406.368,percent of total billed charges,83% of total billed charges for outpatient setting,306,50,,244.8,percent of total billed charges,50% of total billed charges for outpatient setting,306,50,,244.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,239.71,39.17,,191.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,214.2,507.96,
EXP LAP W/COLOSTOMY REVISION,778447,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
TRACHEOSTOMY & PEG TUBE INSERT,778448,CDM,360,RC,,,outpatient,,,1675,837.5,,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.25,35,,469,percent of total billed charges,35% of total billed charges for outpatient setting,1306.5,78,,1045.2,percent of total billed charges,78% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1390.25,83,,1112.2,percent of total billed charges,83% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.06,39.17,,524.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,586.25,1390.25,
ENDOMETRIAL ABLATION,778449,CDM,360,RC,,,outpatient,,,2908,1454,,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1116.67,38.4,,893.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1116.67,38.4,,893.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1017.8,35,,814.24,percent of total billed charges,35% of total billed charges for outpatient setting,2268.24,78,,1814.592,percent of total billed charges,78% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,2035.6,70,,1628.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2181,75,,1744.8,percent of total billed charges,75% of total billed charges for outpatient setting,2413.64,83,,1930.912,percent of total billed charges,83% of total billed charges for outpatient setting,1454,50,,1163.2,percent of total billed charges,50% of total billed charges for outpatient setting,1454,50,,1163.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1139,39.17,,911.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1017.8,2413.64,
EXC. STM W/SKIN GRAFT,778450,CDM,360,RC,,,outpatient,,,1845,922.5,,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,708.48,38.4,,566.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,708.48,38.4,,566.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,1383.75,75,,1107,percent of total billed charges,75% of total billed charges for outpatient setting,1383.75,75,,1107,percent of total billed charges,75% of total billed charges for outpatient setting,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,1383.75,75,,1107,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,645.75,35,,516.6,percent of total billed charges,35% of total billed charges for outpatient setting,1439.1,78,,1151.28,percent of total billed charges,78% of total billed charges for outpatient setting,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,1291.5,70,,1033.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1383.75,75,,1107,percent of total billed charges,75% of total billed charges for outpatient setting,1531.35,83,,1225.08,percent of total billed charges,83% of total billed charges for outpatient setting,922.5,50,,738,percent of total billed charges,50% of total billed charges for outpatient setting,922.5,50,,738,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.65,39.17,,578.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,645.75,1531.35,
REPAIR TRAUMATIC LACERATION,778451,CDM,360,RC,,,outpatient,,,1374,687,,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,527.62,38.4,,422.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,480.9,35,,384.72,percent of total billed charges,35% of total billed charges for outpatient setting,1071.72,78,,857.376,percent of total billed charges,78% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,961.8,70,,769.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1030.5,75,,824.4,percent of total billed charges,75% of total billed charges for outpatient setting,1140.42,83,,912.336,percent of total billed charges,83% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,687,50,,549.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,538.17,39.17,,430.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,480.9,1140.42,
REVISION OF PORT-A-CATH,778452,CDM,360,RC,,,outpatient,,,2342,1171,,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,819.7,35,,655.76,percent of total billed charges,35% of total billed charges for outpatient setting,1826.76,78,,1461.408,percent of total billed charges,78% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1943.86,83,,1555.088,percent of total billed charges,83% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.32,39.17,,733.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,819.7,1943.86,
TRACHEOSTOMY/PEG TUBE INSERTIO,778453,CDM,360,RC,,,outpatient,,,1675,837.5,,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.25,35,,469,percent of total billed charges,35% of total billed charges for outpatient setting,1306.5,78,,1045.2,percent of total billed charges,78% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1390.25,83,,1112.2,percent of total billed charges,83% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.06,39.17,,524.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,586.25,1390.25,
D&C/BREAST LUMPECTOMY,778455,CDM,360,RC,,,outpatient,,,2682,1341,,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1029.89,38.4,,823.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1029.89,38.4,,823.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,2011.5,75,,1609.2,percent of total billed charges,75% of total billed charges for outpatient setting,2011.5,75,,1609.2,percent of total billed charges,75% of total billed charges for outpatient setting,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,2011.5,75,,1609.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,938.7,35,,750.96,percent of total billed charges,35% of total billed charges for outpatient setting,2091.96,78,,1673.568,percent of total billed charges,78% of total billed charges for outpatient setting,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,1877.4,70,,1501.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2011.5,75,,1609.2,percent of total billed charges,75% of total billed charges for outpatient setting,2226.06,83,,1780.848,percent of total billed charges,83% of total billed charges for outpatient setting,1341,50,,1072.8,percent of total billed charges,50% of total billed charges for outpatient setting,1341,50,,1072.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1050.49,39.17,,840.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,938.7,2226.06,
EXCISION LYMPH NODE,778456,CDM,360,RC,38500,HCPCS,outpatient,,,2921,1460.5,,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,3274.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1121.66,38.4,,897.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1121.66,38.4,,897.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,2190.75,75,,1752.6,percent of total billed charges,75% of total billed charges for outpatient setting,2190.75,75,,1752.6,percent of total billed charges,75% of total billed charges for outpatient setting,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,2190.75,75,,1752.6,percent of total billed charges,75% of total billed charges for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1022.35,35,,817.88,percent of total billed charges,35% of total billed charges for outpatient setting,2278.38,78,,1822.704,percent of total billed charges,78% of total billed charges for outpatient setting,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,2044.7,70,,1635.76,percent of total billed charges,70% of total billed charges for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2190.75,75,,1752.6,percent of total billed charges,75% of total billed charges for outpatient setting,2424.43,83,,1939.544,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1144.09,39.17,,915.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1022.35,3274.2,
EXCISION SKIN LESION,778457,CDM,360,RC,,,outpatient,,,1045,522.5,,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,401.28,38.4,,321.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,401.28,38.4,,321.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.75,35,,292.6,percent of total billed charges,35% of total billed charges for outpatient setting,815.1,78,,652.08,percent of total billed charges,78% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,867.35,83,,693.88,percent of total billed charges,83% of total billed charges for outpatient setting,522.5,50,,418,percent of total billed charges,50% of total billed charges for outpatient setting,522.5,50,,418,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,409.31,39.17,,327.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,365.75,867.35,
EXP. LAPAROSCOPY CONVERT LAPAR,778458,CDM,360,RC,,,outpatient,,,3994,1997,,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1533.7,38.4,,1226.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1397.9,35,,1118.32,percent of total billed charges,35% of total billed charges for outpatient setting,3115.32,78,,2492.256,percent of total billed charges,78% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,2795.8,70,,2236.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2995.5,75,,2396.4,percent of total billed charges,75% of total billed charges for outpatient setting,3315.02,83,,2652.016,percent of total billed charges,83% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,1997,50,,1597.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1564.37,39.17,,1251.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1397.9,3315.02,
EGD/POLYP,778460,CDM,360,RC,,,outpatient,,,1376,688,,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.38,38.4,,422.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.38,38.4,,422.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,1032,75,,825.6,percent of total billed charges,75% of total billed charges for outpatient setting,1032,75,,825.6,percent of total billed charges,75% of total billed charges for outpatient setting,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,1032,75,,825.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,481.6,35,,385.28,percent of total billed charges,35% of total billed charges for outpatient setting,1073.28,78,,858.624,percent of total billed charges,78% of total billed charges for outpatient setting,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,963.2,70,,770.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1032,75,,825.6,percent of total billed charges,75% of total billed charges for outpatient setting,1142.08,83,,913.664,percent of total billed charges,83% of total billed charges for outpatient setting,688,50,,550.4,percent of total billed charges,50% of total billed charges for outpatient setting,688,50,,550.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,538.95,39.17,,431.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,481.6,1142.08,
CLOSURE OF TRACH,778461,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
PORT-A-CATH INTRODUCER SET,778462,CDM,270,RC,,,outpatient,,,131,65.5,,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.85,35,,36.68,percent of total billed charges,35% of total billed charges for outpatient setting,102.18,78,,81.744,percent of total billed charges,78% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,108.73,83,,86.984,percent of total billed charges,83% of total billed charges for outpatient setting,65.5,50,,52.4,percent of total billed charges,50% of total billed charges for outpatient setting,65.5,50,,52.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.31,39.17,,41.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.85,108.73,
MIC TRANSGASTRIC-JEJUNAL TUBE,778463,CDM,270,RC,,,outpatient,,,316,158,,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.34,38.4,,97.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.34,38.4,,97.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,237,75,,189.6,percent of total billed charges,75% of total billed charges for outpatient setting,237,75,,189.6,percent of total billed charges,75% of total billed charges for outpatient setting,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,237,75,,189.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.6,35,,88.48,percent of total billed charges,35% of total billed charges for outpatient setting,246.48,78,,197.184,percent of total billed charges,78% of total billed charges for outpatient setting,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,221.2,70,,176.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,237,75,,189.6,percent of total billed charges,75% of total billed charges for outpatient setting,262.28,83,,209.824,percent of total billed charges,83% of total billed charges for outpatient setting,158,50,,126.4,percent of total billed charges,50% of total billed charges for outpatient setting,158,50,,126.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123.77,39.17,,99.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,110.6,262.28,
VIDEO ASSISTED THOROSCOPY,778464,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
LAP CHOLE/EGD,778465,CDM,360,RC,,,outpatient,,,6781,3390.5,,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2603.9,38.4,,2083.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2603.9,38.4,,2083.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,5085.75,75,,4068.6,percent of total billed charges,75% of total billed charges for outpatient setting,5085.75,75,,4068.6,percent of total billed charges,75% of total billed charges for outpatient setting,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,5085.75,75,,4068.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.35,35,,1898.68,percent of total billed charges,35% of total billed charges for outpatient setting,5289.18,78,,4231.344,percent of total billed charges,78% of total billed charges for outpatient setting,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,4746.7,70,,3797.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5085.75,75,,4068.6,percent of total billed charges,75% of total billed charges for outpatient setting,5628.23,83,,4502.584,percent of total billed charges,83% of total billed charges for outpatient setting,3390.5,50,,2712.4,percent of total billed charges,50% of total billed charges for outpatient setting,3390.5,50,,2712.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2655.98,39.17,,2124.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2373.35,5628.23,
LAP SIGMOID COLOSTOMY & DEBRID,778466,CDM,360,RC,,,outpatient,,,6898,3449,,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2648.83,38.4,,2119.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2648.83,38.4,,2119.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,5173.5,75,,4138.8,percent of total billed charges,75% of total billed charges for outpatient setting,5173.5,75,,4138.8,percent of total billed charges,75% of total billed charges for outpatient setting,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,5173.5,75,,4138.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2414.3,35,,1931.44,percent of total billed charges,35% of total billed charges for outpatient setting,5380.44,78,,4304.352,percent of total billed charges,78% of total billed charges for outpatient setting,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,4828.6,70,,3862.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5173.5,75,,4138.8,percent of total billed charges,75% of total billed charges for outpatient setting,5725.34,83,,4580.272,percent of total billed charges,83% of total billed charges for outpatient setting,3449,50,,2759.2,percent of total billed charges,50% of total billed charges for outpatient setting,3449,50,,2759.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2701.81,39.17,,2161.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2414.3,5725.34,
PERMA CATH INSERTION,778467,CDM,360,RC,,,outpatient,,,2342,1171,,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,819.7,35,,655.76,percent of total billed charges,35% of total billed charges for outpatient setting,1826.76,78,,1461.408,percent of total billed charges,78% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1943.86,83,,1555.088,percent of total billed charges,83% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.32,39.17,,733.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,819.7,1943.86,
REPOSITION VENOUS ACCESS CATH,778468,CDM,360,RC,,,outpatient,,,2342,1171,,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,819.7,35,,655.76,percent of total billed charges,35% of total billed charges for outpatient setting,1826.76,78,,1461.408,percent of total billed charges,78% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1943.86,83,,1555.088,percent of total billed charges,83% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.32,39.17,,733.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,819.7,1943.86,
AV FISTULA PROCEDURE,778469,CDM,360,RC,,,outpatient,,,2342,1171,,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.33,38.4,,719.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,819.7,35,,655.76,percent of total billed charges,35% of total billed charges for outpatient setting,1826.76,78,,1461.408,percent of total billed charges,78% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,1639.4,70,,1311.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.5,75,,1405.2,percent of total billed charges,75% of total billed charges for outpatient setting,1943.86,83,,1555.088,percent of total billed charges,83% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,1171,50,,936.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,917.32,39.17,,733.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,819.7,1943.86,
TRACHEOSTOMY & BRONCHOSCOPY,778470,CDM,360,RC,,,outpatient,,,1675,837.5,,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,643.2,38.4,,514.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.25,35,,469,percent of total billed charges,35% of total billed charges for outpatient setting,1306.5,78,,1045.2,percent of total billed charges,78% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,1172.5,70,,938,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1256.25,75,,1005,percent of total billed charges,75% of total billed charges for outpatient setting,1390.25,83,,1112.2,percent of total billed charges,83% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,837.5,50,,670,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.06,39.17,,524.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,586.25,1390.25,
RECTAL EXAM UNDER ANESTHESIA,778471,CDM,360,RC,,,outpatient,,,834,417,,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,320.26,38.4,,256.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,320.26,38.4,,256.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,625.5,75,,500.4,percent of total billed charges,75% of total billed charges for outpatient setting,625.5,75,,500.4,percent of total billed charges,75% of total billed charges for outpatient setting,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,625.5,75,,500.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,291.9,35,,233.52,percent of total billed charges,35% of total billed charges for outpatient setting,650.52,78,,520.416,percent of total billed charges,78% of total billed charges for outpatient setting,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,583.8,70,,467.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,625.5,75,,500.4,percent of total billed charges,75% of total billed charges for outpatient setting,692.22,83,,553.776,percent of total billed charges,83% of total billed charges for outpatient setting,417,50,,333.6,percent of total billed charges,50% of total billed charges for outpatient setting,417,50,,333.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,326.67,39.17,,261.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,291.9,692.22,
SUPRAPUBIC INTRODUCER CATH SET,778474,CDM,270,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
INSERTION OF SUPRAPUBIC CATHET,778475,CDM,360,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
LAPAROSCOPIC LIVER BX,778476,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
LAPAROSCOPY W/OPEN COLECTOMY,778477,CDM,360,RC,,,outpatient,,,6428,3214,,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2468.35,38.4,,1974.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2468.35,38.4,,1974.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,4821,75,,3856.8,percent of total billed charges,75% of total billed charges for outpatient setting,4821,75,,3856.8,percent of total billed charges,75% of total billed charges for outpatient setting,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,4821,75,,3856.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2249.8,35,,1799.84,percent of total billed charges,35% of total billed charges for outpatient setting,5013.84,78,,4011.072,percent of total billed charges,78% of total billed charges for outpatient setting,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,4499.6,70,,3599.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4821,75,,3856.8,percent of total billed charges,75% of total billed charges for outpatient setting,5335.24,83,,4268.192,percent of total billed charges,83% of total billed charges for outpatient setting,3214,50,,2571.2,percent of total billed charges,50% of total billed charges for outpatient setting,3214,50,,2571.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2517.72,39.17,,2014.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2249.8,5335.24,
REMOVAL PORT-A-CATH,778478,CDM,360,RC,,,outpatient,,,1429,714.5,,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,548.74,38.4,,438.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,548.74,38.4,,438.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,1071.75,75,,857.4,percent of total billed charges,75% of total billed charges for outpatient setting,1071.75,75,,857.4,percent of total billed charges,75% of total billed charges for outpatient setting,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,1071.75,75,,857.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,500.15,35,,400.12,percent of total billed charges,35% of total billed charges for outpatient setting,1114.62,78,,891.696,percent of total billed charges,78% of total billed charges for outpatient setting,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,1000.3,70,,800.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1071.75,75,,857.4,percent of total billed charges,75% of total billed charges for outpatient setting,1186.07,83,,948.856,percent of total billed charges,83% of total billed charges for outpatient setting,714.5,50,,571.6,percent of total billed charges,50% of total billed charges for outpatient setting,714.5,50,,571.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,559.71,39.17,,447.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,500.15,1186.07,
LIVER BIOPSY,778479,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
EXC. ANAL LESION,778480,CDM,360,RC,,,outpatient,,,563,281.5,,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.05,35,,157.64,percent of total billed charges,35% of total billed charges for outpatient setting,439.14,78,,351.312,percent of total billed charges,78% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,467.29,83,,373.832,percent of total billed charges,83% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.51,39.17,,176.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,197.05,467.29,
EXC. FACIAL SKIN LESION,778481,CDM,360,RC,,,outpatient,,,1191,595.5,,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,457.34,38.4,,365.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.85,35,,333.48,percent of total billed charges,35% of total billed charges for outpatient setting,928.98,78,,743.184,percent of total billed charges,78% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,833.7,70,,666.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,893.25,75,,714.6,percent of total billed charges,75% of total billed charges for outpatient setting,988.53,83,,790.824,percent of total billed charges,83% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,595.5,50,,476.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.49,39.17,,373.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.85,988.53,
LAP CHOLECYSTECTOMY W/ HERNIA,778482,CDM,360,RC,,,outpatient,,,6182,3091,,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2373.89,38.4,,1899.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2163.7,35,,1730.96,percent of total billed charges,35% of total billed charges for outpatient setting,4821.96,78,,3857.568,percent of total billed charges,78% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,4327.4,70,,3461.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4636.5,75,,3709.2,percent of total billed charges,75% of total billed charges for outpatient setting,5131.06,83,,4104.848,percent of total billed charges,83% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,3091,50,,2472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2421.37,39.17,,1937.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2163.7,5131.06,
PARACENTESIS,778483,CDM,360,RC,,,outpatient,,,471,235.5,,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.85,35,,131.88,percent of total billed charges,35% of total billed charges for outpatient setting,367.38,78,,293.904,percent of total billed charges,78% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.93,83,,312.744,percent of total billed charges,83% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.48,39.17,,147.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,164.85,390.93,
INSERTION OF PICC LINE,778484,CDM,360,RC,36569,HCPCS,outpatient,,,4200,2100,,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1612.8,38.4,,1290.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1612.8,38.4,,1290.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1470,35,,1176,percent of total billed charges,35% of total billed charges for outpatient setting,3276,78,,2620.8,percent of total billed charges,78% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,3486,83,,2788.8,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1645.06,39.17,,1316.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,3486,
LAPAROTOMY,778485,CDM,360,RC,,,outpatient,,,1948,974,,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,748.03,38.4,,598.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.8,35,,545.44,percent of total billed charges,35% of total billed charges for outpatient setting,1519.44,78,,1215.552,percent of total billed charges,78% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,1363.6,70,,1090.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1461,75,,1168.8,percent of total billed charges,75% of total billed charges for outpatient setting,1616.84,83,,1293.472,percent of total billed charges,83% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,974,50,,779.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,762.99,39.17,,610.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,681.8,1616.84,
POWER PORT KIT,778486,CDM,274,RC,C1788,HCPCS,both,,,556,278,,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,389.2,70,,311.36,percent of total billed charges,70% of billed charges for implant carveouts,389.2,70,,311.36,percent of total billed charges,70% of billed charges for implant carveouts,389.2,70,,311.36,percent of total billed charges,70% of billed charges for implant carveouts,444.8,80,,355.84,percent of total billed charges,80% of billed charges for implant carveouts,444.8,80,,355.84,percent of total billed charges,80% of billed charges for implant carveouts,389.2,70,,311.36,percent of total billed charges,70% of billed charges for implant carveouts,444.8,80,,355.84,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.6,35,,155.68,percent of total billed charges,35% of total billed charges for outpatient setting,433.68,78,,346.944,percent of total billed charges,78% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,461.48,83,,369.184,percent of total billed charges,83% of total billed charges for outpatient setting,278,50,,222.4,percent of total billed charges,50% of total billed charges for outpatient setting,278,50,,222.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.77,39.17,,174.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,194.6,461.48,
HEMASTASIS CLIP,778487,CDM,270,RC,,,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
ULTRASOUND/VACUUM ASSISTED BRE,778489,CDM,360,RC,,,outpatient,,,1930,965,,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,741.12,38.4,,592.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.12,38.4,,592.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,675.5,35,,540.4,percent of total billed charges,35% of total billed charges for outpatient setting,1505.4,78,,1204.32,percent of total billed charges,78% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,1351,70,,1080.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1447.5,75,,1158,percent of total billed charges,75% of total billed charges for outpatient setting,1601.9,83,,1281.52,percent of total billed charges,83% of total billed charges for outpatient setting,965,50,,772,percent of total billed charges,50% of total billed charges for outpatient setting,965,50,,772,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,755.94,39.17,,604.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,675.5,1601.9,
MESH - ATRIUM 5X5,778490,CDM,270,RC,C1781,HCPCS,outpatient,,,540,270,,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,207.36,38.4,,165.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,207.36,38.4,,165.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,405,75,,324,percent of total billed charges,75% of total billed charges for outpatient setting,405,75,,324,percent of total billed charges,75% of total billed charges for outpatient setting,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,405,75,,324,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189,35,,151.2,percent of total billed charges,35% of total billed charges for outpatient setting,421.2,78,,336.96,percent of total billed charges,78% of total billed charges for outpatient setting,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,378,70,,302.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,405,75,,324,percent of total billed charges,75% of total billed charges for outpatient setting,448.2,83,,358.56,percent of total billed charges,83% of total billed charges for outpatient setting,270,50,,216,percent of total billed charges,50% of total billed charges for outpatient setting,270,50,,216,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.51,39.17,,169.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,189,448.2,
MESH - ATRIUM 6X8,778491,CDM,270,RC,C1781,HCPCS,outpatient,,,997,498.5,,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,382.85,38.4,,306.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,382.85,38.4,,306.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,747.75,75,,598.2,percent of total billed charges,75% of total billed charges for outpatient setting,747.75,75,,598.2,percent of total billed charges,75% of total billed charges for outpatient setting,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,747.75,75,,598.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348.95,35,,279.16,percent of total billed charges,35% of total billed charges for outpatient setting,777.66,78,,622.128,percent of total billed charges,78% of total billed charges for outpatient setting,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,697.9,70,,558.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,747.75,75,,598.2,percent of total billed charges,75% of total billed charges for outpatient setting,827.51,83,,662.008,percent of total billed charges,83% of total billed charges for outpatient setting,498.5,50,,398.8,percent of total billed charges,50% of total billed charges for outpatient setting,498.5,50,,398.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,390.51,39.17,,312.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,348.95,827.51,
US GUIDE NEEDLE PLACEMENT,778492,CDM,402,RC,76942,HCPCS,outpatient,,,491,245.5,,343.7,70,,274.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,188.54,38.4,,150.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,188.54,38.4,,150.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,171.85,35,,137.48,percent of total billed charges,35% of total billed charges for outpatient setting,382.98,78,,306.384,percent of total billed charges,78% of total billed charges for outpatient setting,343.7,70,,274.96,percent of total billed charges,70% of total billed charges for outpatient setting,343.7,70,,274.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.25,75,,294.6,percent of total billed charges,75% of total billed charges for outpatient setting,407.53,83,,326.024,percent of total billed charges,83% of total billed charges for outpatient setting,785.6,100,,,case rate,100% UHC case rate for outpatient setting,785.6,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.31,39.17,,153.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.66,785.6,
BREAST TISSUE MARKER PLACEMENT,778494,CDM,361,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
ULTRASOUND GUIDED PICC LINE,778495,CDM,360,RC,76937,HCPCS,outpatient,,,537,268.5,,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,206.21,38.4,,164.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.21,38.4,,164.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.95,35,,150.36,percent of total billed charges,35% of total billed charges for outpatient setting,418.86,78,,335.088,percent of total billed charges,78% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,375.9,70,,300.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,402.75,75,,322.2,percent of total billed charges,75% of total billed charges for outpatient setting,445.71,83,,356.568,percent of total billed charges,83% of total billed charges for outpatient setting,268.5,50,,214.8,percent of total billed charges,50% of total billed charges for outpatient setting,268.5,50,,214.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210.33,39.17,,168.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.92,445.71,
STOMA CONE IRRIGATION KIT,778496,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
EXTRA VIEW BALLOON TROCAR,778497,CDM,270,RC,,,outpatient,,,494,247,,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.7,38.4,,151.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.7,38.4,,151.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.9,35,,138.32,percent of total billed charges,35% of total billed charges for outpatient setting,385.32,78,,308.256,percent of total billed charges,78% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,410.02,83,,328.016,percent of total billed charges,83% of total billed charges for outpatient setting,247,50,,197.6,percent of total billed charges,50% of total billed charges for outpatient setting,247,50,,197.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.49,39.17,,154.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,172.9,410.02,
MESH - PARLETEX ROUND,778498,CDM,278,RC,C1781,HCPCS,both,,,832,416,,582.4,70,,465.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,319.49,38.4,,255.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.49,38.4,,255.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.4,70,,465.92,percent of total billed charges,70% of billed charges for implant carveouts,582.4,70,,465.92,percent of total billed charges,70% of billed charges for implant carveouts,582.4,70,,465.92,percent of total billed charges,70% of billed charges for implant carveouts,665.6,80,,532.48,percent of total billed charges,80% of billed charges for implant carveouts,665.6,80,,532.48,percent of total billed charges,80% of billed charges for implant carveouts,582.4,70,,465.92,percent of total billed charges,70% of billed charges for implant carveouts,665.6,80,,532.48,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,291.2,35,,232.96,percent of total billed charges,35% of total billed charges for outpatient setting,648.96,78,,519.168,percent of total billed charges,78% of total billed charges for outpatient setting,582.4,70,,465.92,percent of total billed charges,70% of total billed charges for outpatient setting,582.4,70,,465.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,624,75,,499.2,percent of total billed charges,75% of total billed charges for outpatient setting,690.56,83,,552.448,percent of total billed charges,83% of total billed charges for outpatient setting,416,50,,332.8,percent of total billed charges,50% of total billed charges for outpatient setting,416,50,,332.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,325.88,39.17,,260.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,291.2,690.56,
MESH - PARIETEX RIGHT/LEFT,778499,CDM,278,RC,C1781,HCPCS,both,,,455,227.5,,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.72,38.4,,139.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,174.72,38.4,,139.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,455,70,,364,percent of total billed charges,70% of total billed charges for outpatient setting,455,70,,364,percent of total billed charges,70% of total billed charges for outpatient setting,455,70,,364,percent of total billed charges,70% of total billed charges for outpatient setting,455,75,,364,percent of total billed charges,75% of total billed charges for outpatient setting,455,75,,364,percent of total billed charges,75% of total billed charges for outpatient setting,455,70,,364,percent of total billed charges,70% of total billed charges for outpatient setting,455,75,,364,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.25,35,,127.4,percent of total billed charges,35% of total billed charges for outpatient setting,354.9,78,,283.92,percent of total billed charges,78% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,75,,273,percent of total billed charges,75% of total billed charges for outpatient setting,377.65,83,,302.12,percent of total billed charges,83% of total billed charges for outpatient setting,227.5,50,,182,percent of total billed charges,50% of total billed charges for outpatient setting,227.5,50,,182,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.21,39.17,,142.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,159.25,455,
HERNIA TACKER (ABSORBABLE),778501,CDM,270,RC,,,outpatient,,,876,438,,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336.38,38.4,,269.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336.38,38.4,,269.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,306.6,35,,245.28,percent of total billed charges,35% of total billed charges for outpatient setting,683.28,78,,546.624,percent of total billed charges,78% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,727.08,83,,581.664,percent of total billed charges,83% of total billed charges for outpatient setting,438,50,,350.4,percent of total billed charges,50% of total billed charges for outpatient setting,438,50,,350.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,343.11,39.17,,274.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,306.6,727.08,
MIC-KEY EXTENSION SET,778502,CDM,270,RC,,,outpatient,,,182,91,,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.89,38.4,,55.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.89,38.4,,55.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.7,35,,50.96,percent of total billed charges,35% of total billed charges for outpatient setting,141.96,78,,113.568,percent of total billed charges,78% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,151.06,83,,120.848,percent of total billed charges,83% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.29,39.17,,57.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63.7,151.06,
MINOR SURGICAL PROCEDURE,778503,CDM,360,RC,,,outpatient,,,721,360.5,,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.35,35,,201.88,percent of total billed charges,35% of total billed charges for outpatient setting,562.38,78,,449.904,percent of total billed charges,78% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,598.43,83,,478.744,percent of total billed charges,83% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.4,39.17,,225.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,252.35,598.43,
INSERTION OF 3 LUMEN CATH,778504,CDM,360,RC,,,outpatient,,,376,188,,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.38,38.4,,115.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.38,38.4,,115.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,282,75,,225.6,percent of total billed charges,75% of total billed charges for outpatient setting,282,75,,225.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,282,75,,225.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.6,35,,105.28,percent of total billed charges,35% of total billed charges for outpatient setting,293.28,78,,234.624,percent of total billed charges,78% of total billed charges for outpatient setting,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.2,70,,210.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282,75,,225.6,percent of total billed charges,75% of total billed charges for outpatient setting,312.08,83,,249.664,percent of total billed charges,83% of total billed charges for outpatient setting,188,50,,150.4,percent of total billed charges,50% of total billed charges for outpatient setting,188,50,,150.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.27,39.17,,117.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,131.6,312.08,
REMOVAL KNEE HARDWARE IMPLANTS,778505,CDM,360,RC,,,outpatient,,,1433,716.5,,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,550.27,38.4,,440.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,550.27,38.4,,440.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,501.55,35,,401.24,percent of total billed charges,35% of total billed charges for outpatient setting,1117.74,78,,894.192,percent of total billed charges,78% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,1003.1,70,,802.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1074.75,75,,859.8,percent of total billed charges,75% of total billed charges for outpatient setting,1189.39,83,,951.512,percent of total billed charges,83% of total billed charges for outpatient setting,716.5,50,,573.2,percent of total billed charges,50% of total billed charges for outpatient setting,716.5,50,,573.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,561.28,39.17,,449.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,501.55,1189.39,
BX/REMOVAL LYMPH NODE(S),778506,CDM,360,RC,38510,HCPCS,outpatient,,,4172,2086,,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,3274.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1602.05,38.4,,1281.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1602.05,38.4,,1281.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,3129,75,,2503.2,percent of total billed charges,75% of total billed charges for outpatient setting,3129,75,,2503.2,percent of total billed charges,75% of total billed charges for outpatient setting,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,3129,75,,2503.2,percent of total billed charges,75% of total billed charges for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1460.2,35,,1168.16,percent of total billed charges,35% of total billed charges for outpatient setting,3254.16,78,,2603.328,percent of total billed charges,78% of total billed charges for outpatient setting,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,2920.4,70,,2336.32,percent of total billed charges,70% of total billed charges for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3129,75,,2503.2,percent of total billed charges,75% of total billed charges for outpatient setting,3462.76,83,,2770.208,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.09,39.17,,1307.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,3274.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1460.2,3462.76,
INSERTION TUNNELLED  CATHETER,778507,CDM,360,RC,36563,HCPCS,outpatient,,,4830,2415,,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,4720.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,35,,1352.4,percent of total billed charges,35% of total billed charges for outpatient setting,3767.4,78,,3013.92,percent of total billed charges,78% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,4008.9,83,,3207.12,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1891.81,39.17,,1513.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,4720.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,5560,
CAST REMOVAL,778508,CDM,360,RC,,,outpatient,,,471,235.5,,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.85,35,,131.88,percent of total billed charges,35% of total billed charges for outpatient setting,367.38,78,,293.904,percent of total billed charges,78% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.93,83,,312.744,percent of total billed charges,83% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.48,39.17,,147.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,164.85,390.93,
ORTHO EXAM UNDER FLURO,778509,CDM,360,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
ULTRASOUND GUIDED BIOPSY,778513,CDM,360,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
PLACEMENT OF MIC-KEY TUBE,778514,CDM,360,RC,,,outpatient,,,236,118,,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.6,35,,66.08,percent of total billed charges,35% of total billed charges for outpatient setting,184.08,78,,147.264,percent of total billed charges,78% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,195.88,83,,156.704,percent of total billed charges,83% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.43,39.17,,73.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,82.6,195.88,
CAST APPLICATION,778515,CDM,360,RC,,,outpatient,,,677,338.5,,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.97,38.4,,207.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.95,35,,189.56,percent of total billed charges,35% of total billed charges for outpatient setting,528.06,78,,422.448,percent of total billed charges,78% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,473.9,70,,379.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,507.75,75,,406.2,percent of total billed charges,75% of total billed charges for outpatient setting,561.91,83,,449.528,percent of total billed charges,83% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,338.5,50,,270.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.17,39.17,,212.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,236.95,561.91,
INJECTION ASPIRATION JT W FLUR,778518,CDM,360,RC,76942,HCPCS,outpatient,,,608.52,304.26,,425.96,70,,340.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,233.67,38.4,,186.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.67,38.4,,186.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212.98,35,,170.384,percent of total billed charges,35% of total billed charges for outpatient setting,474.65,78,,379.72,percent of total billed charges,78% of total billed charges for outpatient setting,425.96,70,,340.768,percent of total billed charges,70% of total billed charges for outpatient setting,425.96,70,,340.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.39,75,,365.112,percent of total billed charges,75% of total billed charges for outpatient setting,505.07,83,,404.056,percent of total billed charges,83% of total billed charges for outpatient setting,304.26,50,,243.408,percent of total billed charges,50% of total billed charges for outpatient setting,304.26,50,,243.408,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,238.34,39.17,,190.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.66,505.07,
PHLEBECTOMY,778519,CDM,360,RC,37765,HCPCS,outpatient,,,4403,2201.5,,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1690.75,38.4,,1352.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1690.75,38.4,,1352.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,3302.25,75,,2641.8,percent of total billed charges,75% of total billed charges for outpatient setting,3302.25,75,,2641.8,percent of total billed charges,75% of total billed charges for outpatient setting,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,3302.25,75,,2641.8,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1541.05,35,,1232.84,percent of total billed charges,35% of total billed charges for outpatient setting,3434.34,78,,2747.472,percent of total billed charges,78% of total billed charges for outpatient setting,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,3082.1,70,,2465.68,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3302.25,75,,2641.8,percent of total billed charges,75% of total billed charges for outpatient setting,3654.49,83,,2923.592,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1724.57,39.17,,1379.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1541.05,3868,
ULTRASOUND GUIDED LYMPHNODE BX,778520,CDM,360,RC,,,outpatient,,,1378,689,,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,529.15,38.4,,423.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,529.15,38.4,,423.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,482.3,35,,385.84,percent of total billed charges,35% of total billed charges for outpatient setting,1074.84,78,,859.872,percent of total billed charges,78% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,964.6,70,,771.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1033.5,75,,826.8,percent of total billed charges,75% of total billed charges for outpatient setting,1143.74,83,,914.992,percent of total billed charges,83% of total billed charges for outpatient setting,689,50,,551.2,percent of total billed charges,50% of total billed charges for outpatient setting,689,50,,551.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.73,39.17,,431.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,482.3,1143.74,
EXICISION ELBOW BURSA,778521,CDM,360,RC,24105,HCPCS,outpatient,,,1582,791,,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,607.49,38.4,,485.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,607.49,38.4,,485.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges for outpatient setting,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges for outpatient setting,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,553.7,35,,442.96,percent of total billed charges,35% of total billed charges for outpatient setting,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges for outpatient setting,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,1107.4,70,,885.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1186.5,75,,949.2,percent of total billed charges,75% of total billed charges for outpatient setting,1313.06,83,,1050.448,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,619.64,39.17,,495.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,553.7,3141,
EXCISION BAKER'S CYST,778522,CDM,360,RC,27345,HCPCS,outpatient,,,1698,849,,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,652.03,38.4,,521.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,652.03,38.4,,521.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,1273.5,75,,1018.8,percent of total billed charges,75% of total billed charges for outpatient setting,1273.5,75,,1018.8,percent of total billed charges,75% of total billed charges for outpatient setting,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,1273.5,75,,1018.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.3,35,,475.44,percent of total billed charges,35% of total billed charges for outpatient setting,1324.44,78,,1059.552,percent of total billed charges,78% of total billed charges for outpatient setting,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,1188.6,70,,950.88,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1273.5,75,,1018.8,percent of total billed charges,75% of total billed charges for outpatient setting,1409.34,83,,1127.472,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,665.07,39.17,,532.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.3,3141,
D/C OPT PROCEDURE PRIOR ANESTH,778523,CDM,360,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
D/C OPT PROCEDURE AFTER ANESTH,778524,CDM,360,RC,,,outpatient,,,309,154.5,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,118.66,38.4,,94.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.66,38.4,,94.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,231.75,75,,185.4,percent of total billed charges,75% of total billed charges for outpatient setting,231.75,75,,185.4,percent of total billed charges,75% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,231.75,75,,185.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.15,35,,86.52,percent of total billed charges,35% of total billed charges for outpatient setting,241.02,78,,192.816,percent of total billed charges,78% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231.75,75,,185.4,percent of total billed charges,75% of total billed charges for outpatient setting,256.47,83,,205.176,percent of total billed charges,83% of total billed charges for outpatient setting,154.5,50,,123.6,percent of total billed charges,50% of total billed charges for outpatient setting,154.5,50,,123.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.03,39.17,,96.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,108.15,256.47,
NEEDLE ASPIRATION,778525,CDM,360,RC,,,outpatient,,,471,235.5,,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.85,35,,131.88,percent of total billed charges,35% of total billed charges for outpatient setting,367.38,78,,293.904,percent of total billed charges,78% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.93,83,,312.744,percent of total billed charges,83% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,235.5,50,,188.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.48,39.17,,147.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,164.85,390.93,
EXC SEBACEOUS CYST,778526,CDM,360,RC,,,outpatient,,,1769,884.5,,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,679.3,38.4,,543.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,679.3,38.4,,543.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,1326.75,75,,1061.4,percent of total billed charges,75% of total billed charges for outpatient setting,1326.75,75,,1061.4,percent of total billed charges,75% of total billed charges for outpatient setting,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,1326.75,75,,1061.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,619.15,35,,495.32,percent of total billed charges,35% of total billed charges for outpatient setting,1379.82,78,,1103.856,percent of total billed charges,78% of total billed charges for outpatient setting,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,1238.3,70,,990.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1326.75,75,,1061.4,percent of total billed charges,75% of total billed charges for outpatient setting,1468.27,83,,1174.616,percent of total billed charges,83% of total billed charges for outpatient setting,884.5,50,,707.6,percent of total billed charges,50% of total billed charges for outpatient setting,884.5,50,,707.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,692.89,39.17,,554.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,619.15,1468.27,
SURGICAL REPROCESSING,778528,CDM,360,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
REPROCESSING CALLBACK FEE,778529,CDM,360,RC,,,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,35,,15.96,percent of total billed charges,35% of total billed charges for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.33,39.17,,17.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.95,47.31,
SCREENING FLEX SIGMOIDOSCOPY,778530,CDM,360,RC,G0104,HCPCS,outpatient,,,1712,856,,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,657.41,38.4,,525.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,657.41,38.4,,525.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,599.2,35,,479.36,percent of total billed charges,35% of total billed charges for outpatient setting,1335.36,78,,1068.288,percent of total billed charges,78% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1420.96,83,,1136.768,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,670.56,39.17,,536.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,599.2,1452,
EX REPAIR ARM ARTERY,778531,CDM,360,RC,,,outpatient,,,14610.75,7305.38,,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5610.53,38.4,,4488.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5610.53,38.4,,4488.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,10958.06,75,,8766.448,percent of total billed charges,75% of total billed charges for outpatient setting,10958.06,75,,8766.448,percent of total billed charges,75% of total billed charges for outpatient setting,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,10958.06,75,,8766.448,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5113.76,35,,4091.008,percent of total billed charges,35% of total billed charges for outpatient setting,11396.39,78,,9117.112,percent of total billed charges,78% of total billed charges for outpatient setting,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,10227.53,70,,8182.024,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10958.06,75,,8766.448,percent of total billed charges,75% of total billed charges for outpatient setting,12126.92,83,,9701.536,percent of total billed charges,83% of total billed charges for outpatient setting,7305.38,50,,5844.304,percent of total billed charges,50% of total billed charges for outpatient setting,7305.38,50,,5844.304,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5722.74,39.17,,4578.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5113.76,12126.92,
MEDIAL/FACET LUMBAR/SACRAL SINGLE LEVEL,778532,CDM,360,RC,,,outpatient,,,1915,957.5,,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,735.36,38.4,,588.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,735.36,38.4,,588.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,1436.25,75,,1149,percent of total billed charges,75% of total billed charges for outpatient setting,1436.25,75,,1149,percent of total billed charges,75% of total billed charges for outpatient setting,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,1436.25,75,,1149,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,670.25,35,,536.2,percent of total billed charges,35% of total billed charges for outpatient setting,1493.7,78,,1194.96,percent of total billed charges,78% of total billed charges for outpatient setting,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,1340.5,70,,1072.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1436.25,75,,1149,percent of total billed charges,75% of total billed charges for outpatient setting,1589.45,83,,1271.56,percent of total billed charges,83% of total billed charges for outpatient setting,957.5,50,,766,percent of total billed charges,50% of total billed charges for outpatient setting,957.5,50,,766,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,750.07,39.17,,600.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,670.25,1589.45,
MEDIAL/FACET LUMBAR/SACRAL SECOND LEVEL,778533,CDM,360,RC,,,outpatient,,,995,497.5,,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348.25,35,,278.6,percent of total billed charges,35% of total billed charges for outpatient setting,776.1,78,,620.88,percent of total billed charges,78% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,825.85,83,,660.68,percent of total billed charges,83% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,389.72,39.17,,311.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,348.25,825.85,
MEDIAL/FACET LUMBAR/SACRAL THIRD LEVEL,778534,CDM,360,RC,,,outpatient,,,995,497.5,,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348.25,35,,278.6,percent of total billed charges,35% of total billed charges for outpatient setting,776.1,78,,620.88,percent of total billed charges,78% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,825.85,83,,660.68,percent of total billed charges,83% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,389.72,39.17,,311.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,348.25,825.85,
ASPIR OR INJECT JT/BURSA,778535,CDM,360,RC,,,outpatient,,,262,131,,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.61,38.4,,80.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.61,38.4,,80.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.7,35,,73.36,percent of total billed charges,35% of total billed charges for outpatient setting,204.36,78,,163.488,percent of total billed charges,78% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,217.46,83,,173.968,percent of total billed charges,83% of total billed charges for outpatient setting,131,50,,104.8,percent of total billed charges,50% of total billed charges for outpatient setting,131,50,,104.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.62,39.17,,82.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,91.7,217.46,
FLUOROSCOPIC GUIDANCE,778536,CDM,360,RC,,,outpatient,,,729,364.5,,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255.15,35,,204.12,percent of total billed charges,35% of total billed charges for outpatient setting,568.62,78,,454.896,percent of total billed charges,78% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,605.07,83,,484.056,percent of total billed charges,83% of total billed charges for outpatient setting,364.5,50,,291.6,percent of total billed charges,50% of total billed charges for outpatient setting,364.5,50,,291.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,285.54,39.17,,228.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,255.15,605.07,
SYNDESMOSIS TIGHTROPE XP IMPLANT SS AR-8,778537,CDM,360,RC,,,outpatient,,,4500,2250,,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1728,38.4,,1382.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1728,38.4,,1382.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,3375,75,,2700,percent of total billed charges,75% of total billed charges for outpatient setting,3375,75,,2700,percent of total billed charges,75% of total billed charges for outpatient setting,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,3375,75,,2700,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1575,35,,1260,percent of total billed charges,35% of total billed charges for outpatient setting,3510,78,,2808,percent of total billed charges,78% of total billed charges for outpatient setting,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,3150,70,,2520,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3375,75,,2700,percent of total billed charges,75% of total billed charges for outpatient setting,3735,83,,2988,percent of total billed charges,83% of total billed charges for outpatient setting,2250,50,,1800,percent of total billed charges,50% of total billed charges for outpatient setting,2250,50,,1800,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1762.56,39.17,,1410.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1575,3735,
SCREW 2.7X14 MM LOCKING AR-8827CL-14,778538,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW 4.0X55 MM AR-8840C-55,778539,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
SCREW COMP FT 2.5X40MM AR-8725-40H,778540,CDM,278,RC,C1713,HCPCS,both,,,3975,1987.5,,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1391.25,35,,1113,percent of total billed charges,35% of total billed charges for outpatient setting,3100.5,78,,2480.4,percent of total billed charges,78% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2981.25,75,,2385,percent of total billed charges,75% of total billed charges for outpatient setting,3299.25,83,,2639.4,percent of total billed charges,83% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1556.93,39.17,,1245.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1391.25,3299.25,
SCREW 2.7X14 MM LOCKING AR 8827CL-14,778541,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
DRILL BIT 2.2,778542,CDM,278,RC,C1713,HCPCS,both,,,585,292.5,,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,224.64,38.4,,179.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224.64,38.4,,179.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.5,70,,327.6,percent of total billed charges,70% of billed charges for implant carveouts,409.5,70,,327.6,percent of total billed charges,70% of billed charges for implant carveouts,409.5,70,,327.6,percent of total billed charges,70% of billed charges for implant carveouts,468,80,,374.4,percent of total billed charges,80% of billed charges for implant carveouts,468,80,,374.4,percent of total billed charges,80% of billed charges for implant carveouts,409.5,70,,327.6,percent of total billed charges,70% of billed charges for implant carveouts,468,80,,374.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.75,35,,163.8,percent of total billed charges,35% of total billed charges for outpatient setting,456.3,78,,365.04,percent of total billed charges,78% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,438.75,75,,351,percent of total billed charges,75% of total billed charges for outpatient setting,485.55,83,,388.44,percent of total billed charges,83% of total billed charges for outpatient setting,292.5,50,,234,percent of total billed charges,50% of total billed charges for outpatient setting,292.5,50,,234,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,229.13,39.17,,183.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,204.75,485.55,
SCREW 2.7X16 MM NON LOCKING,778543,CDM,278,RC,C1713,HCPCS,both,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.5,190,
SCREW 2.7X18 MM NON LOCKING,778544,CDM,278,RC,C1713,HCPCS,both,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,190,70,,152,percent of total billed charges,70% of total billed charges for outpatient setting,190,75,,152,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.5,190,
SCREW 2.7X16 MM LOCKING,778545,CDM,278,RC,C1713,HCPCS,both,,,910,455,,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,637,70,,509.6,percent of total billed charges,70% of billed charges for implant carveouts,637,70,,509.6,percent of total billed charges,70% of billed charges for implant carveouts,637,70,,509.6,percent of total billed charges,70% of billed charges for implant carveouts,728,80,,582.4,percent of total billed charges,80% of billed charges for implant carveouts,728,80,,582.4,percent of total billed charges,80% of billed charges for implant carveouts,637,70,,509.6,percent of total billed charges,70% of billed charges for implant carveouts,728,80,,582.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.5,35,,254.8,percent of total billed charges,35% of total billed charges for outpatient setting,709.8,78,,567.84,percent of total billed charges,78% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,682.5,75,,546,percent of total billed charges,75% of total billed charges for outpatient setting,755.3,83,,604.24,percent of total billed charges,83% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,356.43,39.17,,285.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,318.5,755.3,
SCREW 2.7X20 MM LOCKING,778546,CDM,278,RC,C1713,HCPCS,both,,,705,352.5,,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.75,35,,197.4,percent of total billed charges,35% of total billed charges for outpatient setting,549.9,78,,439.92,percent of total billed charges,78% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,585.15,83,,468.12,percent of total billed charges,83% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.13,39.17,,220.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.75,585.15,
SCREW 2.7X22 MM LOCKING,778547,CDM,278,RC,C1713,HCPCS,both,,,705,352.5,,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,493.5,70,,394.8,percent of total billed charges,70% of billed charges for implant carveouts,564,80,,451.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.75,35,,197.4,percent of total billed charges,35% of total billed charges for outpatient setting,549.9,78,,439.92,percent of total billed charges,78% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,585.15,83,,468.12,percent of total billed charges,83% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.13,39.17,,220.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.75,585.15,
PLATE -DVR STND PLATE LEFT,778548,CDM,360,RC,,,outpatient,,,5600,2800,,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2150.4,38.4,,1720.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2150.4,38.4,,1720.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,4200,75,,3360,percent of total billed charges,75% of total billed charges for outpatient setting,4200,75,,3360,percent of total billed charges,75% of total billed charges for outpatient setting,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,4200,75,,3360,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1960,35,,1568,percent of total billed charges,35% of total billed charges for outpatient setting,4368,78,,3494.4,percent of total billed charges,78% of total billed charges for outpatient setting,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,3920,70,,3136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4200,75,,3360,percent of total billed charges,75% of total billed charges for outpatient setting,4648,83,,3718.4,percent of total billed charges,83% of total billed charges for outpatient setting,2800,50,,2240,percent of total billed charges,50% of total billed charges for outpatient setting,2800,50,,2240,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2193.41,39.17,,1754.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1960,4648,
PLATE - 6H LT LOCKING DISTAL FIB AR 8943,778549,CDM,278,RC,C1713,HCPCS,both,,,2400,1200,,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,840,35,,672,percent of total billed charges,35% of total billed charges for outpatient setting,1872,78,,1497.6,percent of total billed charges,78% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1800,75,,1440,percent of total billed charges,75% of total billed charges for outpatient setting,1992,83,,1593.6,percent of total billed charges,83% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,940.03,39.17,,752.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,840,1992,
SCREW 2.7X16 MM LOCKING AR 8827CL-16,778550,CDM,278,RC,C1713,HCPCS,both,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of billed charges for implant carveouts,1445.5,70,,1156.4,percent of total billed charges,70% of billed charges for implant carveouts,1445.5,70,,1156.4,percent of total billed charges,70% of billed charges for implant carveouts,1652,80,,1321.6,percent of total billed charges,80% of billed charges for implant carveouts,1652,80,,1321.6,percent of total billed charges,80% of billed charges for implant carveouts,1445.5,70,,1156.4,percent of total billed charges,70% of billed charges for implant carveouts,1652,80,,1321.6,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW 2.7X12 MM LOCKING AR 8827CL-12,778551,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
DRILL BIT LONG 2.5 AR 8843-42,778552,CDM,278,RC,C1713,HCPCS,both,,,255,127.5,,178.5,70,,142.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.92,38.4,,78.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.92,38.4,,78.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,255,70,,204,percent of total billed charges,70% of total billed charges for outpatient setting,255,70,,204,percent of total billed charges,70% of total billed charges for outpatient setting,255,70,,204,percent of total billed charges,70% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,255,70,,204,percent of total billed charges,70% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,35,,71.4,percent of total billed charges,35% of total billed charges for outpatient setting,198.9,78,,159.12,percent of total billed charges,78% of total billed charges for outpatient setting,178.5,70,,142.8,percent of total billed charges,70% of total billed charges for outpatient setting,178.5,70,,142.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,191.25,75,,153,percent of total billed charges,75% of total billed charges for outpatient setting,211.65,83,,169.32,percent of total billed charges,83% of total billed charges for outpatient setting,127.5,50,,102,percent of total billed charges,50% of total billed charges for outpatient setting,127.5,50,,102,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.88,39.17,,79.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,89.25,255,
SCREW SHORT THREAD 4.0X45 AR 8840C-40,778553,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
GUIDE WIRE - .39GUIDE WIRE - AR-8737-39,778554,CDM,270,RC,,,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.85,92.13,
GUIDE WIRE -- AR-8741-14,778555,CDM,270,RC,,,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.5,207.5,
SCREW 3.5X50 MM AR-8735BV-50,778556,CDM,278,RC,C1713,HCPCS,both,,,3975,1987.5,,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1391.25,35,,1113,percent of total billed charges,35% of total billed charges for outpatient setting,3100.5,78,,2480.4,percent of total billed charges,78% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2981.25,75,,2385,percent of total billed charges,75% of total billed charges for outpatient setting,3299.25,83,,2639.4,percent of total billed charges,83% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1556.93,39.17,,1245.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1391.25,3299.25,
SCREW 3.5X16 MM CORTICAL  AR 8835-16,778557,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW 2.7X18 MM LOCK AR 8827CL-18,778558,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW 3.5X18 MM CORTICALAR 8835-18,778559,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW 4.0X50 MM LAG AR-8840C-50,778560,CDM,278,RC,C1713,HCPCS,both,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,70,,396,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,495,
GUIDE WIRE -  AR-8943-07,778561,CDM,270,RC,,,outpatient,,,600,300,,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,230.4,38.4,,184.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.4,38.4,,184.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,450,75,,360,percent of total billed charges,75% of total billed charges for outpatient setting,450,75,,360,percent of total billed charges,75% of total billed charges for outpatient setting,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,450,75,,360,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210,35,,168,percent of total billed charges,35% of total billed charges for outpatient setting,468,78,,374.4,percent of total billed charges,78% of total billed charges for outpatient setting,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,420,70,,336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,450,75,,360,percent of total billed charges,75% of total billed charges for outpatient setting,498,83,,398.4,percent of total billed charges,83% of total billed charges for outpatient setting,300,50,,240,percent of total billed charges,50% of total billed charges for outpatient setting,300,50,,240,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.01,39.17,,188.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,210,498,
DRILL CANNULATED AR 8741-25S,778562,CDM,278,RC,C1713,HCPCS,both,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,682.5,70,,546,percent of total billed charges,70% of billed charges for implant carveouts,780,80,,624,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,35,,273,percent of total billed charges,35% of total billed charges for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.89,39.17,,305.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,341.25,809.25,
SCREW BEVELED FT 3.5X50MM AR-8735BV-50,778563,CDM,278,RC,C1713,HCPCS,both,,,3975,1987.5,,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1526.4,38.4,,1221.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,2782.5,70,,2226,percent of total billed charges,70% of billed charges for implant carveouts,3180,80,,2544,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1391.25,35,,1113,percent of total billed charges,35% of total billed charges for outpatient setting,3100.5,78,,2480.4,percent of total billed charges,78% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,2782.5,70,,2226,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2981.25,75,,2385,percent of total billed charges,75% of total billed charges for outpatient setting,3299.25,83,,2639.4,percent of total billed charges,83% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,1987.5,50,,1590,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1556.93,39.17,,1245.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1391.25,3299.25,
3 HOLE PLATE RIGHTSTANDARD  AR8916VNR-03,778564,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW 3.5X16MM CORTICAL AR 8935-16,778565,CDM,278,RC,C1713,HCPCS,both,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,180,
5 HOLE PLATE RIGHTSTANDARD  AR8916VNR-05,778566,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
ANCHOR 2.9 JUGGER KNOT REF 912029,778567,CDM,278,RC,C1713,HCPCS,both,,,2050,1025,,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,787.2,38.4,,629.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,787.2,38.4,,629.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1435,70,,1148,percent of total billed charges,70% of billed charges for implant carveouts,1435,70,,1148,percent of total billed charges,70% of billed charges for implant carveouts,1435,70,,1148,percent of total billed charges,70% of billed charges for implant carveouts,1640,80,,1312,percent of total billed charges,80% of billed charges for implant carveouts,1640,80,,1312,percent of total billed charges,80% of billed charges for implant carveouts,1435,70,,1148,percent of total billed charges,70% of billed charges for implant carveouts,1640,80,,1312,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,717.5,35,,574,percent of total billed charges,35% of total billed charges for outpatient setting,1599,78,,1279.2,percent of total billed charges,78% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1537.5,75,,1230,percent of total billed charges,75% of total billed charges for outpatient setting,1701.5,83,,1361.2,percent of total billed charges,83% of total billed charges for outpatient setting,1025,50,,820,percent of total billed charges,50% of total billed charges for outpatient setting,1025,50,,820,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,802.94,39.17,,642.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,717.5,1701.5,
KIT 2.9 JUGGER KNOT REF 912057,778568,CDM,278,RC,C1713,HCPCS,both,,,1650,825,,1155,70,,924,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,633.6,38.4,,506.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,633.6,38.4,,506.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1155,70,,924,percent of total billed charges,70% of billed charges for implant carveouts,1155,70,,924,percent of total billed charges,70% of billed charges for implant carveouts,1155,70,,924,percent of total billed charges,70% of billed charges for implant carveouts,1320,80,,1056,percent of total billed charges,80% of billed charges for implant carveouts,1320,80,,1056,percent of total billed charges,80% of billed charges for implant carveouts,1155,70,,924,percent of total billed charges,70% of billed charges for implant carveouts,1320,80,,1056,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,35,,462,percent of total billed charges,35% of total billed charges for outpatient setting,1287,78,,1029.6,percent of total billed charges,78% of total billed charges for outpatient setting,1155,70,,924,percent of total billed charges,70% of total billed charges for outpatient setting,1155,70,,924,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1237.5,75,,990,percent of total billed charges,75% of total billed charges for outpatient setting,1369.5,83,,1095.6,percent of total billed charges,83% of total billed charges for outpatient setting,825,50,,660,percent of total billed charges,50% of total billed charges for outpatient setting,825,50,,660,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,646.27,39.17,,517.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,577.5,1369.5,
BC SX ANCHOR LOCK 3.5X19.5MM  AR-1926BC,778569,CDM,278,RC,C1713,HCPCS,both,,,1200,600,,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,420,35,,336,percent of total billed charges,35% of total billed charges for outpatient setting,936,78,,748.8,percent of total billed charges,78% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,996,83,,796.8,percent of total billed charges,83% of total billed charges for outpatient setting,600,50,,480,percent of total billed charges,50% of total billed charges for outpatient setting,600,50,,480,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,470.02,39.17,,376.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,420,996,
DX SL W/ CLOSEDEYE 5.5X19.1MM AR 2323BCC,778570,CDM,278,RC,C1713,HCPCS,both,,,1200,600,,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,840,70,,672,percent of total billed charges,70% of billed charges for implant carveouts,960,80,,768,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,420,35,,336,percent of total billed charges,35% of total billed charges for outpatient setting,936,78,,748.8,percent of total billed charges,78% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,996,83,,796.8,percent of total billed charges,83% of total billed charges for outpatient setting,600,50,,480,percent of total billed charges,50% of total billed charges for outpatient setting,600,50,,480,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,470.02,39.17,,376.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,420,996,
FIBERLINK AR 7535,778571,CDM,270,RC,C1713,HCPCS,outpatient,,,225,112.5,,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,35,,63,percent of total billed charges,35% of total billed charges for outpatient setting,175.5,78,,140.4,percent of total billed charges,78% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,83,,149.4,percent of total billed charges,83% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.13,39.17,,70.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.75,186.75,
MESH - PARIETEX RT TECT1510ADPR,778572,CDM,278,RC,C1781,HCPCS,both,,,391,195.5,,273.7,70,,218.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.14,38.4,,120.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.14,38.4,,120.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,391,70,,312.8,percent of total billed charges,70% of total billed charges for outpatient setting,391,70,,312.8,percent of total billed charges,70% of total billed charges for outpatient setting,391,70,,312.8,percent of total billed charges,70% of total billed charges for outpatient setting,391,75,,312.8,percent of total billed charges,75% of total billed charges for outpatient setting,391,75,,312.8,percent of total billed charges,75% of total billed charges for outpatient setting,391,70,,312.8,percent of total billed charges,70% of total billed charges for outpatient setting,391,75,,312.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.85,35,,109.48,percent of total billed charges,35% of total billed charges for outpatient setting,304.98,78,,243.984,percent of total billed charges,78% of total billed charges for outpatient setting,273.7,70,,218.96,percent of total billed charges,70% of total billed charges for outpatient setting,273.7,70,,218.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.25,75,,234.6,percent of total billed charges,75% of total billed charges for outpatient setting,324.53,83,,259.624,percent of total billed charges,83% of total billed charges for outpatient setting,195.5,50,,156.4,percent of total billed charges,50% of total billed charges for outpatient setting,195.5,50,,156.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153.14,39.17,,122.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.85,391,
MESH - PARIETEX LT REF TECT1510ADPL,778573,CDM,278,RC,C1781,HCPCS,both,,,295,147.5,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295,70,,236,percent of total billed charges,70% of total billed charges for outpatient setting,295,70,,236,percent of total billed charges,70% of total billed charges for outpatient setting,295,70,,236,percent of total billed charges,70% of total billed charges for outpatient setting,295,75,,236,percent of total billed charges,75% of total billed charges for outpatient setting,295,75,,236,percent of total billed charges,75% of total billed charges for outpatient setting,295,70,,236,percent of total billed charges,70% of total billed charges for outpatient setting,295,75,,236,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.25,35,,82.6,percent of total billed charges,35% of total billed charges for outpatient setting,230.1,78,,184.08,percent of total billed charges,78% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,244.85,83,,195.88,percent of total billed charges,83% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.55,39.17,,92.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,103.25,295,
MESH - PROLENE 3X6,778574,CDM,278,RC,C1781,HCPCS,both,,,294,147,,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.9,35,,82.32,percent of total billed charges,35% of total billed charges for outpatient setting,229.32,78,,183.456,percent of total billed charges,78% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,244.02,83,,195.216,percent of total billed charges,83% of total billed charges for outpatient setting,147,50,,117.6,percent of total billed charges,50% of total billed charges for outpatient setting,147,50,,117.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.16,39.17,,92.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.9,294,
MESH - PARIETEX COMPOSITE 6,778575,CDM,278,RC,C1781,HCPCS,both,,,2346,1173,,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,900.86,38.4,,720.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,900.86,38.4,,720.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,821.1,35,,656.88,percent of total billed charges,35% of total billed charges for outpatient setting,1829.88,78,,1463.904,percent of total billed charges,78% of total billed charges for outpatient setting,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1759.5,75,,1407.6,percent of total billed charges,75% of total billed charges for outpatient setting,1947.18,83,,1557.744,percent of total billed charges,83% of total billed charges for outpatient setting,1173,50,,938.4,percent of total billed charges,50% of total billed charges for outpatient setting,1173,50,,938.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.88,39.17,,735.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,821.1,1947.18,
MESH - VENTRALIGHT 4.5CMX11.4CM CIRCLE,778576,CDM,278,RC,C1781,HCPCS,both,,,2985,1492.5,,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1146.24,38.4,,916.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1146.24,38.4,,916.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1044.75,35,,835.8,percent of total billed charges,35% of total billed charges for outpatient setting,2328.3,78,,1862.64,percent of total billed charges,78% of total billed charges for outpatient setting,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2238.75,75,,1791,percent of total billed charges,75% of total billed charges for outpatient setting,2477.55,83,,1982.04,percent of total billed charges,83% of total billed charges for outpatient setting,1492.5,50,,1194,percent of total billed charges,50% of total billed charges for outpatient setting,1492.5,50,,1194,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1169.16,39.17,,935.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1044.75,2477.55,
PLATE -  6 HOLEPLATE 7007-0106 R,778577,CDM,278,RC,C1713,HCPCS,both,,,2610,1305,,1827,70,,1461.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1002.24,38.4,,801.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1002.24,38.4,,801.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1827,70,,1461.6,percent of total billed charges,70% of billed charges for implant carveouts,1827,70,,1461.6,percent of total billed charges,70% of billed charges for implant carveouts,1827,70,,1461.6,percent of total billed charges,70% of billed charges for implant carveouts,2088,80,,1670.4,percent of total billed charges,80% of billed charges for implant carveouts,2088,80,,1670.4,percent of total billed charges,80% of billed charges for implant carveouts,1827,70,,1461.6,percent of total billed charges,70% of billed charges for implant carveouts,2088,80,,1670.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.5,35,,730.8,percent of total billed charges,35% of total billed charges for outpatient setting,2035.8,78,,1628.64,percent of total billed charges,78% of total billed charges for outpatient setting,1827,70,,1461.6,percent of total billed charges,70% of total billed charges for outpatient setting,1827,70,,1461.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1957.5,75,,1566,percent of total billed charges,75% of total billed charges for outpatient setting,2166.3,83,,1733.04,percent of total billed charges,83% of total billed charges for outpatient setting,1305,50,,1044,percent of total billed charges,50% of total billed charges for outpatient setting,1305,50,,1044,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1022.28,39.17,,817.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,913.5,2166.3,
MESH - VENTRALIGHT ST 6'X8' ELLIPSE,778578,CDM,278,RC,C1781,HCPCS,both,,,186,93,,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,186,70,,148.8,percent of total billed charges,70% of total billed charges for outpatient setting,186,75,,148.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.1,35,,52.08,percent of total billed charges,35% of total billed charges for outpatient setting,145.08,78,,116.064,percent of total billed charges,78% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.38,83,,123.504,percent of total billed charges,83% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.85,39.17,,58.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,65.1,186,
DRILL BIT 2.5 AR 8943-06,778579,CDM,278,RC,C1713,HCPCS,both,,,238,119,,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.39,38.4,,73.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.39,38.4,,73.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,75,,190.4,percent of total billed charges,75% of total billed charges for outpatient setting,238,75,,190.4,percent of total billed charges,75% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,75,,190.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.3,35,,66.64,percent of total billed charges,35% of total billed charges for outpatient setting,185.64,78,,148.512,percent of total billed charges,78% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.5,75,,142.8,percent of total billed charges,75% of total billed charges for outpatient setting,197.54,83,,158.032,percent of total billed charges,83% of total billed charges for outpatient setting,119,50,,95.2,percent of total billed charges,50% of total billed charges for outpatient setting,119,50,,95.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.22,39.17,,74.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,83.3,238,
PLATE - WRIST SPANNING PLATE TI 8916SPN,778580,CDM,278,RC,C1713,HCPCS,both,,,5385,2692.5,,3769.5,70,,3015.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2067.84,38.4,,1654.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2067.84,38.4,,1654.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3769.5,70,,3015.6,percent of total billed charges,70% of billed charges for implant carveouts,3769.5,70,,3015.6,percent of total billed charges,70% of billed charges for implant carveouts,3769.5,70,,3015.6,percent of total billed charges,70% of billed charges for implant carveouts,4308,80,,3446.4,percent of total billed charges,80% of billed charges for implant carveouts,4308,80,,3446.4,percent of total billed charges,80% of billed charges for implant carveouts,3769.5,70,,3015.6,percent of total billed charges,70% of billed charges for implant carveouts,4308,80,,3446.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1884.75,35,,1507.8,percent of total billed charges,35% of total billed charges for outpatient setting,4200.3,78,,3360.24,percent of total billed charges,78% of total billed charges for outpatient setting,3769.5,70,,3015.6,percent of total billed charges,70% of total billed charges for outpatient setting,3769.5,70,,3015.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4038.75,75,,3231,percent of total billed charges,75% of total billed charges for outpatient setting,4469.55,83,,3575.64,percent of total billed charges,83% of total billed charges for outpatient setting,2692.5,50,,2154,percent of total billed charges,50% of total billed charges for outpatient setting,2692.5,50,,2154,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2109.2,39.17,,1687.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1884.75,4469.55,
SCREW 2.4X18 MM CORTICAL AR 8724-18,778581,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
SCREW 2.4X12MM CORTICAL AR 8724-12,778582,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
SCREW 3.5X14 MM NON LOCKING 30-0235,778585,CDM,278,RC,C1713,HCPCS,both,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.1,246,
PLATE - LEFT NARROW ZIMMER,778586,CDM,278,RC,C1713,HCPCS,both,,,5590,2795,,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3913,70,,3130.4,percent of total billed charges,70% of billed charges for implant carveouts,3913,70,,3130.4,percent of total billed charges,70% of billed charges for implant carveouts,3913,70,,3130.4,percent of total billed charges,70% of billed charges for implant carveouts,4472,80,,3577.6,percent of total billed charges,80% of billed charges for implant carveouts,4472,80,,3577.6,percent of total billed charges,80% of billed charges for implant carveouts,3913,70,,3130.4,percent of total billed charges,70% of billed charges for implant carveouts,4472,80,,3577.6,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1956.5,35,,1565.2,percent of total billed charges,35% of total billed charges for outpatient setting,4360.2,78,,3488.16,percent of total billed charges,78% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,4639.7,83,,3711.76,percent of total billed charges,83% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2189.49,39.17,,1751.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1956.5,4639.7,
SCREW 2.7X12 MM CORTICAL,778587,CDM,278,RC,C1713,HCPCS,both,,,445,222.5,,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445,70,,356,percent of total billed charges,70% of total billed charges for outpatient setting,445,70,,356,percent of total billed charges,70% of total billed charges for outpatient setting,445,70,,356,percent of total billed charges,70% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,445,70,,356,percent of total billed charges,70% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.75,35,,124.6,percent of total billed charges,35% of total billed charges for outpatient setting,347.1,78,,277.68,percent of total billed charges,78% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,369.35,83,,295.48,percent of total billed charges,83% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.3,39.17,,139.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,155.75,445,
SCREW 2.7X18 MM LOCKING,778588,CDM,278,RC,C1713,HCPCS,both,,,710,355,,497,70,,397.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,272.64,38.4,,218.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,272.64,38.4,,218.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,497,70,,397.6,percent of total billed charges,70% of billed charges for implant carveouts,497,70,,397.6,percent of total billed charges,70% of billed charges for implant carveouts,497,70,,397.6,percent of total billed charges,70% of billed charges for implant carveouts,568,80,,454.4,percent of total billed charges,80% of billed charges for implant carveouts,568,80,,454.4,percent of total billed charges,80% of billed charges for implant carveouts,497,70,,397.6,percent of total billed charges,70% of billed charges for implant carveouts,568,80,,454.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,248.5,35,,198.8,percent of total billed charges,35% of total billed charges for outpatient setting,553.8,78,,443.04,percent of total billed charges,78% of total billed charges for outpatient setting,497,70,,397.6,percent of total billed charges,70% of total billed charges for outpatient setting,497,70,,397.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,532.5,75,,426,percent of total billed charges,75% of total billed charges for outpatient setting,589.3,83,,471.44,percent of total billed charges,83% of total billed charges for outpatient setting,355,50,,284,percent of total billed charges,50% of total billed charges for outpatient setting,355,50,,284,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,278.09,39.17,,222.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,248.5,589.3,
REAMP THIGH THRU FEMUR ANY LEV,778589,CDM,360,RC,27596,HCPCS,outpatient,,,2771,1385.5,,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,2771,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1064.06,38.4,,851.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1064.06,38.4,,851.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,2078.25,75,,1662.6,percent of total billed charges,75% of total billed charges for outpatient setting,2078.25,75,,1662.6,percent of total billed charges,75% of total billed charges for outpatient setting,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,2078.25,75,,1662.6,percent of total billed charges,75% of total billed charges for outpatient setting,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,969.85,35,,775.88,percent of total billed charges,35% of total billed charges for outpatient setting,2161.38,78,,1729.104,percent of total billed charges,78% of total billed charges for outpatient setting,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,1939.7,70,,1551.76,percent of total billed charges,70% of total billed charges for outpatient setting,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2078.25,75,,1662.6,percent of total billed charges,75% of total billed charges for outpatient setting,2299.93,83,,1839.944,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1085.34,39.17,,868.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2771,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,969.85,5560,
SUTURE QUAD/HAMSTRINGS MUSCLE,778590,CDM,360,RC,,,outpatient,,,2332,1166,,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,895.49,38.4,,716.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.49,38.4,,716.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,1749,75,,1399.2,percent of total billed charges,75% of total billed charges for outpatient setting,1749,75,,1399.2,percent of total billed charges,75% of total billed charges for outpatient setting,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,1749,75,,1399.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.2,35,,652.96,percent of total billed charges,35% of total billed charges for outpatient setting,1818.96,78,,1455.168,percent of total billed charges,78% of total billed charges for outpatient setting,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,1632.4,70,,1305.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1749,75,,1399.2,percent of total billed charges,75% of total billed charges for outpatient setting,1935.56,83,,1548.448,percent of total billed charges,83% of total billed charges for outpatient setting,1166,50,,932.8,percent of total billed charges,50% of total billed charges for outpatient setting,1166,50,,932.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,913.4,39.17,,730.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,816.2,1935.56,
INCISION EXTENS TENDON SHEAT W,778591,CDM,360,RC,,,outpatient,,,2325,1162.5,,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,892.8,38.4,,714.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,892.8,38.4,,714.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,1743.75,75,,1395,percent of total billed charges,75% of total billed charges for outpatient setting,1743.75,75,,1395,percent of total billed charges,75% of total billed charges for outpatient setting,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,1743.75,75,,1395,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,813.75,35,,651,percent of total billed charges,35% of total billed charges for outpatient setting,1813.5,78,,1450.8,percent of total billed charges,78% of total billed charges for outpatient setting,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,1627.5,70,,1302,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1743.75,75,,1395,percent of total billed charges,75% of total billed charges for outpatient setting,1929.75,83,,1543.8,percent of total billed charges,83% of total billed charges for outpatient setting,1162.5,50,,930,percent of total billed charges,50% of total billed charges for outpatient setting,1162.5,50,,930,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,910.66,39.17,,728.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,813.75,1929.75,
ARTHROPLASTY INTERPOSITION /CARPAL JOINT,778592,CDM,360,RC,,,outpatient,,,2410,1205,,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,925.44,38.4,,740.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,925.44,38.4,,740.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,1807.5,75,,1446,percent of total billed charges,75% of total billed charges for outpatient setting,1807.5,75,,1446,percent of total billed charges,75% of total billed charges for outpatient setting,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,1807.5,75,,1446,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,843.5,35,,674.8,percent of total billed charges,35% of total billed charges for outpatient setting,1879.8,78,,1503.84,percent of total billed charges,78% of total billed charges for outpatient setting,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,1687,70,,1349.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1807.5,75,,1446,percent of total billed charges,75% of total billed charges for outpatient setting,2000.3,83,,1600.24,percent of total billed charges,83% of total billed charges for outpatient setting,1205,50,,964,percent of total billed charges,50% of total billed charges for outpatient setting,1205,50,,964,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,943.95,39.17,,755.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,843.5,2000.3,
ENDOSCOPI CARPAL TUNNEL RELEASE,778593,CDM,360,RC,,,outpatient,,,1480,740,,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,568.32,38.4,,454.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,568.32,38.4,,454.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,518,35,,414.4,percent of total billed charges,35% of total billed charges for outpatient setting,1154.4,78,,923.52,percent of total billed charges,78% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,1036,70,,828.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1110,75,,888,percent of total billed charges,75% of total billed charges for outpatient setting,1228.4,83,,982.72,percent of total billed charges,83% of total billed charges for outpatient setting,740,50,,592,percent of total billed charges,50% of total billed charges for outpatient setting,740,50,,592,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,579.69,39.17,,463.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,518,1228.4,
ORIF LATERAL MALLEOULUS FX,778594,CDM,360,RC,,,outpatient,,,1870,935,,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,718.08,38.4,,574.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,718.08,38.4,,574.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,1402.5,75,,1122,percent of total billed charges,75% of total billed charges for outpatient setting,1402.5,75,,1122,percent of total billed charges,75% of total billed charges for outpatient setting,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,1402.5,75,,1122,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,654.5,35,,523.6,percent of total billed charges,35% of total billed charges for outpatient setting,1458.6,78,,1166.88,percent of total billed charges,78% of total billed charges for outpatient setting,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,1309,70,,1047.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1402.5,75,,1122,percent of total billed charges,75% of total billed charges for outpatient setting,1552.1,83,,1241.68,percent of total billed charges,83% of total billed charges for outpatient setting,935,50,,748,percent of total billed charges,50% of total billed charges for outpatient setting,935,50,,748,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,732.44,39.17,,585.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,654.5,1552.1,
ACHILLES MID SUB  IMPLANTS AR-8862DS,778595,CDM,278,RC,C1776,HCPCS,both,,,4485,2242.5,,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3139.5,70,,2511.6,percent of total billed charges,70% of billed charges for implant carveouts,3139.5,70,,2511.6,percent of total billed charges,70% of billed charges for implant carveouts,3139.5,70,,2511.6,percent of total billed charges,70% of billed charges for implant carveouts,3588,80,,2870.4,percent of total billed charges,80% of billed charges for implant carveouts,3588,80,,2870.4,percent of total billed charges,80% of billed charges for implant carveouts,3139.5,70,,2511.6,percent of total billed charges,70% of billed charges for implant carveouts,3588,80,,2870.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1569.75,35,,1255.8,percent of total billed charges,35% of total billed charges for outpatient setting,3498.3,78,,2798.64,percent of total billed charges,78% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3722.55,83,,2978.04,percent of total billed charges,83% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.68,39.17,,1405.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1569.75,3722.55,
INJ W/US PVRT FACET CERVICAL OR THORACIC,778596,CDM,360,RC,,,outpatient,,,301,150.5,,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.58,38.4,,92.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.58,38.4,,92.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.35,35,,84.28,percent of total billed charges,35% of total billed charges for outpatient setting,234.78,78,,187.824,percent of total billed charges,78% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,249.83,83,,199.864,percent of total billed charges,83% of total billed charges for outpatient setting,150.5,50,,120.4,percent of total billed charges,50% of total billed charges for outpatient setting,150.5,50,,120.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.89,39.17,,94.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,105.35,249.83,
INJ W/US PVRT FACET CERVICAL OR THORACIC,778597,CDM,360,RC,,,outpatient,,,261,130.5,,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.22,38.4,,80.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.22,38.4,,80.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.35,35,,73.08,percent of total billed charges,35% of total billed charges for outpatient setting,203.58,78,,162.864,percent of total billed charges,78% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,182.7,70,,146.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,195.75,75,,156.6,percent of total billed charges,75% of total billed charges for outpatient setting,216.63,83,,173.304,percent of total billed charges,83% of total billed charges for outpatient setting,130.5,50,,104.4,percent of total billed charges,50% of total billed charges for outpatient setting,130.5,50,,104.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.22,39.17,,81.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,91.35,216.63,
AXILLARY NERVE W/ IMAGING GUIDANCE,778598,CDM,360,RC,,,outpatient,,,424,212,,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.82,38.4,,130.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.82,38.4,,130.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.4,35,,118.72,percent of total billed charges,35% of total billed charges for outpatient setting,330.72,78,,264.576,percent of total billed charges,78% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,351.92,83,,281.536,percent of total billed charges,83% of total billed charges for outpatient setting,212,50,,169.6,percent of total billed charges,50% of total billed charges for outpatient setting,212,50,,169.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.08,39.17,,132.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.4,351.92,
PHASE I RECOVERY 30 MIN,800010,CDM,710,RC,,,outpatient,,,900.2,450.1,,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,345.68,38.4,,276.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345.68,38.4,,276.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,675.15,75,,540.12,percent of total billed charges,75% of total billed charges for outpatient setting,675.15,75,,540.12,percent of total billed charges,75% of total billed charges for outpatient setting,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,675.15,75,,540.12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315.07,35,,252.056,percent of total billed charges,35% of total billed charges for outpatient setting,702.16,78,,561.728,percent of total billed charges,78% of total billed charges for outpatient setting,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,630.14,70,,504.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,675.15,75,,540.12,percent of total billed charges,75% of total billed charges for outpatient setting,747.17,83,,597.736,percent of total billed charges,83% of total billed charges for outpatient setting,450.1,50,,360.08,percent of total billed charges,50% of total billed charges for outpatient setting,450.1,50,,360.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,352.59,39.17,,282.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,315.07,747.17,
EACH ADDITION 15 MIN,800012,CDM,710,RC,,,outpatient,,,455,227.5,,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.72,38.4,,139.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,174.72,38.4,,139.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,341.25,75,,273,percent of total billed charges,75% of total billed charges for outpatient setting,341.25,75,,273,percent of total billed charges,75% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,341.25,75,,273,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.25,35,,127.4,percent of total billed charges,35% of total billed charges for outpatient setting,354.9,78,,283.92,percent of total billed charges,78% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,318.5,70,,254.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,75,,273,percent of total billed charges,75% of total billed charges for outpatient setting,377.65,83,,302.12,percent of total billed charges,83% of total billed charges for outpatient setting,227.5,50,,182,percent of total billed charges,50% of total billed charges for outpatient setting,227.5,50,,182,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.21,39.17,,142.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,159.25,377.65,
CRITICAL CARE PHASE 1 30 MIN,800017,CDM,710,RC,,,outpatient,,,551,275.5,,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.58,38.4,,169.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.58,38.4,,169.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,413.25,75,,330.6,percent of total billed charges,75% of total billed charges for outpatient setting,413.25,75,,330.6,percent of total billed charges,75% of total billed charges for outpatient setting,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,413.25,75,,330.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.85,35,,154.28,percent of total billed charges,35% of total billed charges for outpatient setting,429.78,78,,343.824,percent of total billed charges,78% of total billed charges for outpatient setting,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,385.7,70,,308.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,413.25,75,,330.6,percent of total billed charges,75% of total billed charges for outpatient setting,457.33,83,,365.864,percent of total billed charges,83% of total billed charges for outpatient setting,275.5,50,,220.4,percent of total billed charges,50% of total billed charges for outpatient setting,275.5,50,,220.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.81,39.17,,172.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.85,457.33,
CATHERIZATION SIMPLE,800102,CDM,710,RC,51702,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
CODE BLUE,800103,CDM,710,RC,92950,HCPCS,outpatient,,,485,242.5,,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,35,,135.8,percent of total billed charges,35% of total billed charges for outpatient setting,378.3,78,,302.64,percent of total billed charges,78% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,402.55,83,,322.04,percent of total billed charges,83% of total billed charges for outpatient setting,242.5,50,,194,percent of total billed charges,50% of total billed charges for outpatient setting,242.5,50,,194,percent of total billed charges,50% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,189.96,39.17,,151.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,402.55,
COLLECTION BLOOD/IMPLANTED DEV,800104,CDM,710,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
INJECTION ADM VACCINE/TAXOID,800105,CDM,710,RC,90471,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM THERAPEUTIC,800106,CDM,710,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IV THERAPEUTIC,800107,CDM,710,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV TRANQUILIZER,800108,CDM,710,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION SQ,800109,CDM,710,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
"INSERT CATH, RESIDUAL URINE",800110,CDM,710,RC,51701,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
IV INFUSION EACH ADD'L HOUR,800111,CDM,710,RC,96366,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,50.63,
IV INFUSION HYDRATION,800112,CDM,710,RC,96360,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
IV INFUSION 1ST HOUR,800113,CDM,710,RC,96365,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,293.82,
IV HYDRATION EACH ADD HOUR,800114,CDM,450,RC,96361,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,50.63,
INJECTION IM ANTIOBIOTIC,980001,CDM,760,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM THERAPEUTIC,980002,CDM,760,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM STEROID,980003,CDM,760,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IV ANTIBIOTIC,980006,CDM,760,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
IV INFUSION EACH ADD L HOUR,980011,CDM,760,RC,96366,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,50.63,
INJECTION TOXOID,980012,CDM,760,RC,90471,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
PHASE II RECOVERY,980013,CDM,710,RC,,,outpatient,,,367,183.5,,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,140.93,38.4,,112.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.93,38.4,,112.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,275.25,75,,220.2,percent of total billed charges,75% of total billed charges for outpatient setting,275.25,75,,220.2,percent of total billed charges,75% of total billed charges for outpatient setting,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,275.25,75,,220.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.45,35,,102.76,percent of total billed charges,35% of total billed charges for outpatient setting,286.26,78,,229.008,percent of total billed charges,78% of total billed charges for outpatient setting,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,256.9,70,,205.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,275.25,75,,220.2,percent of total billed charges,75% of total billed charges for outpatient setting,304.61,83,,243.688,percent of total billed charges,83% of total billed charges for outpatient setting,183.5,50,,146.8,percent of total billed charges,50% of total billed charges for outpatient setting,183.5,50,,146.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.75,39.17,,115,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,128.45,304.61,
BONE MARROW ASPIRATE,980014,CDM,360,RC,38220,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
BONE MARROW BIOPSY,980015,CDM,360,RC,38221,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
CATHERIZATION SIMPLE,980016,CDM,360,RC,51702,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,659,
CODE BLUE,980017,CDM,480,RC,92950,HCPCS,outpatient,,,485,242.5,,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,35,,135.8,percent of total billed charges,35% of total billed charges for outpatient setting,378.3,78,,302.64,percent of total billed charges,78% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,402.55,83,,322.04,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,189.96,39.17,,151.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,424,
INJECTION ADM VACCINE/TAXOID,980019,CDM,760,RC,90471,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM THERAPEUTIC,980020,CDM,761,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IV THERAPUTIC,980021,CDM,761,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV TRANQUILIZER,980022,CDM,761,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION SQ,980023,CDM,760,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
"INSERT CATH, RESIDUAL URINE",980024,CDM,761,RC,51701,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
IV INFUSION EACH ADD L HOUR,980025,CDM,260,RC,96366,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,212,
IV INFUSION HYDRATION,980026,CDM,760,RC,96360,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
IV INFUSION IST HOUR,980027,CDM,260,RC,96365,HCPCS,outpatient,,,177,88.5,,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.97,38.4,,54.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.97,38.4,,54.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.95,35,,49.56,percent of total billed charges,35% of total billed charges for outpatient setting,138.06,78,,110.448,percent of total billed charges,78% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.91,83,,117.528,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.33,39.17,,55.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.95,212,
LUMBAR PUNCTURE,980028,CDM,360,RC,62270,HCPCS,outpatient,,,729,364.5,,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,255.15,35,,204.12,percent of total billed charges,35% of total billed charges for outpatient setting,568.62,78,,454.896,percent of total billed charges,78% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,605.07,83,,484.056,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.54,39.17,,228.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,255.15,1452,
PARACENTESIS/THORACENTESIS,980029,CDM,361,RC,,,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,85.49,
REPLACE GASTROSTOMY TUBE,980030,CDM,761,RC,43246,HCPCS,outpatient,,,2085,1042.5,,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.64,38.4,,640.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,729.75,35,,583.8,percent of total billed charges,35% of total billed charges for outpatient setting,1626.3,78,,1301.04,percent of total billed charges,78% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1459.5,70,,1167.6,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1563.75,75,,1251,percent of total billed charges,75% of total billed charges for outpatient setting,1730.55,83,,1384.44,percent of total billed charges,83% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1042.5,50,,834,percent of total billed charges,50% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,816.65,39.17,,653.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,729.75,1730.55,
EVALUATION/ MANAGEMENT LEVEL 1,980031,CDM,761,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
EVALUATION/ MANAGEMENT LEVEL 1,980032,CDM,761,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
ER CHRG/MED. ONLY,1000020,CDM,450,RC,99281,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,75,70,,60,percent of total billed charges,70% of total billed charges for outpatient setting,75,70,,60,percent of total billed charges,70% of total billed charges for outpatient setting,75,70,,60,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,70,,60,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,105,,,case rate,105% ER case rate for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,132,
INCISION OF A THROMBOSED HEMOR,1000021,CDM,450,RC,46083,HCPCS,outpatient,,,435,217.5,,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,167.04,38.4,,133.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.04,38.4,,133.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,35,,121.8,percent of total billed charges,35% of total billed charges for outpatient setting,339.3,78,,271.44,percent of total billed charges,78% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,361.05,83,,288.84,percent of total billed charges,83% of total billed charges for outpatient setting,217.5,50,,174,percent of total billed charges,50% of total billed charges for outpatient setting,217.5,50,,174,percent of total billed charges,50% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.38,39.17,,136.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,361.05,
CHRG/MED. ONLY,1000060,CDM,761,RC,99281,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.25,35,,32.2,percent of total billed charges,35% of total billed charges for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.04,39.17,,36.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.25,115,
TRAUMA/CODE CARE,1000095,CDM,450,RC,99291,HCPCS,outpatient,,,850,425,,595,70,,476,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,326.4,38.4,,261.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,326.4,38.4,,261.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,850,70,,680,percent of total billed charges,70% of total billed charges for outpatient setting,850,70,,680,percent of total billed charges,70% of total billed charges for outpatient setting,850,70,,680,percent of total billed charges,70% of total billed charges for outpatient setting,850,75,,680,percent of total billed charges,75% of total billed charges for outpatient setting,850,75,,680,percent of total billed charges,75% of total billed charges for outpatient setting,595,70,,476,percent of total billed charges,70% of total billed charges for outpatient setting,850,75,,680,percent of total billed charges,75% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,297.5,35,,238,percent of total billed charges,35% of total billed charges for outpatient setting,663,78,,530.4,percent of total billed charges,78% of total billed charges for outpatient setting,595,70,,476,percent of total billed charges,70% of total billed charges for outpatient setting,595,70,,476,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,637.5,75,,510,percent of total billed charges,75% of total billed charges for outpatient setting,705.5,83,,564.4,percent of total billed charges,83% of total billed charges for outpatient setting,425,50,,340,percent of total billed charges,50% of total billed charges for outpatient setting,425,50,,340,percent of total billed charges,50% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,332.93,39.17,,266.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,297.5,850,
E.R.EM LEVEL-2,1000097,CDM,450,RC,99282,HCPCS,outpatient,,,464.2,232.1,,324.94,70,,259.952,percent of total billed charges,70% of total billed charges for outpatient setting,140.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,178.25,100,,,case rate,100% ER case rate for outpatient setting,178.25,100,,,case rate,100% ER case rate for outpatient setting,464.2,70,,371.36,percent of total billed charges,70% of total billed charges for outpatient setting,464.2,70,,371.36,percent of total billed charges,70% of total billed charges for outpatient setting,464.2,70,,371.36,percent of total billed charges,70% of total billed charges for outpatient setting,464.2,75,,371.36,percent of total billed charges,75% of total billed charges for outpatient setting,464.2,75,,371.36,percent of total billed charges,75% of total billed charges for outpatient setting,464.2,70,,371.36,percent of total billed charges,70% of total billed charges for outpatient setting,464.2,75,,371.36,percent of total billed charges,75% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162.47,105,,,case rate,105% ER case rate for outpatient setting,362.08,78,,289.664,percent of total billed charges,78% of total billed charges for outpatient setting,324.94,70,,259.952,percent of total billed charges,70% of total billed charges for outpatient setting,324.94,70,,259.952,percent of total billed charges,70% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,348.15,75,,278.52,percent of total billed charges,75% of total billed charges for outpatient setting,385.29,83,,308.232,percent of total billed charges,83% of total billed charges for outpatient setting,232.1,50,,185.68,percent of total billed charges,50% of total billed charges for outpatient setting,232.1,50,,185.68,percent of total billed charges,50% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,464.2,
E.R.EM LEVEL-3,1000098,CDM,450,RC,99283,HCPCS,outpatient,,,633,316.5,,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,245.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,243.07,100,,,case rate,100% ER case rate for outpatient setting,243.07,100,,,case rate,100% ER case rate for outpatient setting,633,70,,506.4,percent of total billed charges,70% of total billed charges for outpatient setting,633,70,,506.4,percent of total billed charges,70% of total billed charges for outpatient setting,633,70,,506.4,percent of total billed charges,70% of total billed charges for outpatient setting,633,75,,506.4,percent of total billed charges,75% of total billed charges for outpatient setting,633,75,,506.4,percent of total billed charges,75% of total billed charges for outpatient setting,633,70,,506.4,percent of total billed charges,70% of total billed charges for outpatient setting,633,75,,506.4,percent of total billed charges,75% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.55,105,,,case rate,105% ER case rate for outpatient setting,493.74,78,,394.992,percent of total billed charges,78% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,474.75,75,,379.8,percent of total billed charges,75% of total billed charges for outpatient setting,525.39,83,,420.312,percent of total billed charges,83% of total billed charges for outpatient setting,316.5,50,,253.2,percent of total billed charges,50% of total billed charges for outpatient setting,316.5,50,,253.2,percent of total billed charges,50% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,633,
E.R.EM LEVEL 1,1000099,CDM,450,RC,99281,HCPCS,outpatient,,,379.8,189.9,,265.86,70,,212.688,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,379.8,70,,303.84,percent of total billed charges,70% of total billed charges for outpatient setting,379.8,70,,303.84,percent of total billed charges,70% of total billed charges for outpatient setting,379.8,70,,303.84,percent of total billed charges,70% of total billed charges for outpatient setting,379.8,75,,303.84,percent of total billed charges,75% of total billed charges for outpatient setting,379.8,75,,303.84,percent of total billed charges,75% of total billed charges for outpatient setting,379.8,70,,303.84,percent of total billed charges,70% of total billed charges for outpatient setting,379.8,75,,303.84,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,105,,,case rate,105% ER case rate for outpatient setting,296.24,78,,236.992,percent of total billed charges,78% of total billed charges for outpatient setting,265.86,70,,212.688,percent of total billed charges,70% of total billed charges for outpatient setting,265.86,70,,212.688,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,284.85,75,,227.88,percent of total billed charges,75% of total billed charges for outpatient setting,315.23,83,,252.184,percent of total billed charges,83% of total billed charges for outpatient setting,189.9,50,,151.92,percent of total billed charges,50% of total billed charges for outpatient setting,189.9,50,,151.92,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,379.8,
E.R.EM LEVEL 4,1000100,CDM,450,RC,99284,HCPCS,outpatient,,,844,422,,590.8,70,,472.64,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,324.1,100,,,case rate,100% ER case rate for outpatient setting,324.1,100,,,case rate,100% ER case rate for outpatient setting,844,70,,675.2,percent of total billed charges,70% of total billed charges for outpatient setting,844,70,,675.2,percent of total billed charges,70% of total billed charges for outpatient setting,844,70,,675.2,percent of total billed charges,70% of total billed charges for outpatient setting,844,75,,675.2,percent of total billed charges,75% of total billed charges for outpatient setting,844,75,,675.2,percent of total billed charges,75% of total billed charges for outpatient setting,844,70,,675.2,percent of total billed charges,70% of total billed charges for outpatient setting,844,75,,675.2,percent of total billed charges,75% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.4,105,,,case rate,105% ER case rate for outpatient setting,658.32,78,,526.656,percent of total billed charges,78% of total billed charges for outpatient setting,590.8,70,,472.64,percent of total billed charges,70% of total billed charges for outpatient setting,590.8,70,,472.64,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,633,75,,506.4,percent of total billed charges,75% of total billed charges for outpatient setting,700.52,83,,560.416,percent of total billed charges,83% of total billed charges for outpatient setting,422,50,,337.6,percent of total billed charges,50% of total billed charges for outpatient setting,422,50,,337.6,percent of total billed charges,50% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,844,
E.R.EM LEVEL 5,1000101,CDM,450,RC,99285,HCPCS,outpatient,,,1055,527.5,,738.5,70,,590.8,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,405.12,100,,,case rate,100% ER case rate for outpatient setting,405.12,100,,,case rate,100% ER case rate for outpatient setting,1055,70,,844,percent of total billed charges,70% of total billed charges for outpatient setting,1055,70,,844,percent of total billed charges,70% of total billed charges for outpatient setting,1055,70,,844,percent of total billed charges,70% of total billed charges for outpatient setting,1055,75,,844,percent of total billed charges,75% of total billed charges for outpatient setting,1055,75,,844,percent of total billed charges,75% of total billed charges for outpatient setting,1055,70,,844,percent of total billed charges,70% of total billed charges for outpatient setting,1055,75,,844,percent of total billed charges,75% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,369.25,105,,,case rate,105% ER case rate for outpatient setting,822.9,78,,658.32,percent of total billed charges,78% of total billed charges for outpatient setting,738.5,70,,590.8,percent of total billed charges,70% of total billed charges for outpatient setting,738.5,70,,590.8,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,791.25,75,,633,percent of total billed charges,75% of total billed charges for outpatient setting,875.65,83,,700.52,percent of total billed charges,83% of total billed charges for outpatient setting,527.5,50,,422,percent of total billed charges,50% of total billed charges for outpatient setting,527.5,50,,422,percent of total billed charges,50% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,1055,
SCREENING FEE,1000105,CDM,450,RC,99281,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,105,,,case rate,105% ER case rate for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,132,
CAST REMOVAL,1000107,CDM,450,RC,99281,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,50,100,,,case rate,100% ER case rate for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,115,70,,92,percent of total billed charges,70% of total billed charges for outpatient setting,115,75,,92,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,105,,,case rate,105% ER case rate for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,102,,,case rate,102% ER case rate for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50,132,
IV SEDATION FEE,1000110,CDM,450,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
CAST PL KN-FT,1000123,CDM,270,RC,,,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
CAST PL ANKLE,1000124,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
CAST PL LG ARM,1000125,CDM,270,RC,,,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.05,52.29,
CAST SYN KN-FT,1000126,CDM,270,RC,,,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56,35,,44.8,percent of total billed charges,35% of total billed charges for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.67,39.17,,50.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56,132.8,
CAST SYN SH ARM,1000127,CDM,270,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
CAST SYN WALK BOOT,1000128,CDM,270,RC,,,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.35,35,,33.88,percent of total billed charges,35% of total billed charges for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.39,39.17,,37.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42.35,100.43,
SPLINT LONG ARM,1000132,CDM,274,RC,A4570,HCPCS,both,,,110,55,,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,110,70,,88,percent of total billed charges,70% of total billed charges for outpatient setting,110,75,,88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.5,35,,30.8,percent of total billed charges,35% of total billed charges for outpatient setting,85.8,78,,68.64,percent of total billed charges,78% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,91.3,83,,73.04,percent of total billed charges,83% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.08,39.17,,34.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.5,110,
CAST PL TH-FT ADULT,1000134,CDM,270,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
CAST PL KN-FT CHILD,1000135,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
CAST PL SH ARM ADULT,1000136,CDM,270,RC,,,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,35,,15.12,percent of total billed charges,35% of total billed charges for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.15,39.17,,16.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.9,44.82,
CAST SYN SH ARM CHIL,1000139,CDM,270,RC,,,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,53.12,
FINGER SPLINT SM,1000140,CDM,274,RC,A4570,HCPCS,both,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,15,
SPLINT LONG LEG SM,1000143,CDM,274,RC,A4570,HCPCS,both,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.2,132,
SPLINT SHORT ARM,1000144,CDM,274,RC,A4570,HCPCS,both,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73,70,,58.4,percent of total billed charges,70% of total billed charges for outpatient setting,73,70,,58.4,percent of total billed charges,70% of total billed charges for outpatient setting,73,70,,58.4,percent of total billed charges,70% of total billed charges for outpatient setting,73,75,,58.4,percent of total billed charges,75% of total billed charges for outpatient setting,73,75,,58.4,percent of total billed charges,75% of total billed charges for outpatient setting,73,70,,58.4,percent of total billed charges,70% of total billed charges for outpatient setting,73,75,,58.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,73,
SYR CATH TIP DISP,1000145,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
CAST PL WALKING,1000146,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
CAST PL KN-FT,1000147,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
CAST PL TH-FT,1000148,CDM,270,RC,,,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,46.48,
CAST SYN ANKLE ADULT,1000149,CDM,270,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
CAST SYN LG ARM,1000150,CDM,270,RC,,,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.35,35,,33.88,percent of total billed charges,35% of total billed charges for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.39,39.17,,37.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42.35,100.43,
CAST SYN TH-FT ADULT,1000151,CDM,270,RC,,,outpatient,,,218,109,,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.3,35,,61.04,percent of total billed charges,35% of total billed charges for outpatient setting,170.04,78,,136.032,percent of total billed charges,78% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.94,83,,144.752,percent of total billed charges,83% of total billed charges for outpatient setting,109,50,,87.2,percent of total billed charges,50% of total billed charges for outpatient setting,109,50,,87.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.38,39.17,,68.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,76.3,180.94,
SPLINT SHORT LEG,1000157,CDM,274,RC,A4570,HCPCS,both,,,97,48.5,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.95,35,,27.16,percent of total billed charges,35% of total billed charges for outpatient setting,75.66,78,,60.528,percent of total billed charges,78% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.51,83,,64.408,percent of total billed charges,83% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38,39.17,,30.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.95,97,
EXT PACEMAKER,1000164,CDM,450,RC,92953,HCPCS,outpatient,,,329,164.5,,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.34,38.4,,101.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,35,,92.12,percent of total billed charges,35% of total billed charges for outpatient setting,256.62,78,,205.296,percent of total billed charges,78% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.3,70,,184.24,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.75,75,,197.4,percent of total billed charges,75% of total billed charges for outpatient setting,273.07,83,,218.456,percent of total billed charges,83% of total billed charges for outpatient setting,164.5,50,,131.6,percent of total billed charges,50% of total billed charges for outpatient setting,164.5,50,,131.6,percent of total billed charges,50% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.87,39.17,,103.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,559.04,
ECG/PACE PAD,1000165,CDM,270,RC,,,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.34,38.4,,24.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.34,38.4,,24.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.65,35,,22.12,percent of total billed charges,35% of total billed charges for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.95,39.17,,24.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.65,65.57,
SHORT LEG SPLINT MED,1000167,CDM,274,RC,A4570,HCPCS,both,,,97,48.5,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.95,35,,27.16,percent of total billed charges,35% of total billed charges for outpatient setting,75.66,78,,60.528,percent of total billed charges,78% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.51,83,,64.408,percent of total billed charges,83% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38,39.17,,30.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.95,97,
SHORT LEG SPLINT SM,1000168,CDM,274,RC,A4570,HCPCS,both,,,97,48.5,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,97,70,,77.6,percent of total billed charges,70% of total billed charges for outpatient setting,97,75,,77.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.95,35,,27.16,percent of total billed charges,35% of total billed charges for outpatient setting,75.66,78,,60.528,percent of total billed charges,78% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.51,83,,64.408,percent of total billed charges,83% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38,39.17,,30.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.95,97,
FULL LEG SPLINT MED,1000169,CDM,274,RC,A4570,HCPCS,both,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.2,132,
FULL LEG SPLINT LG,1000170,CDM,274,RC,A4570,HCPCS,both,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.2,132,
FINGER SPLINT MED,1000171,CDM,274,RC,A4570,HCPCS,both,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,15,
FINGER SPLINT LARGE,1000172,CDM,274,RC,A4570,HCPCS,both,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,70,,12,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,15,
PERF.TEMP CAUTERY,1000173,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
BANDNET X FT 1,1000178,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BANDNET X FT 3,1000179,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BANDNET X FT 5,1000180,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BANDNET X FT 6,1000181,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BANDNET X FT 9,1000182,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
CELACAST SYN X RL 2,1000189,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
CELACAST SYN X RL 3,1000190,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
CELACAST SYN X RL 4,1000191,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
CELACAST SYN X RL 5,1000192,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
ARM SLING (CHILDREN),1000200,CDM,274,RC,A4565,HCPCS,both,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40,70,,32,percent of total billed charges,70% of total billed charges for outpatient setting,40,70,,32,percent of total billed charges,70% of total billed charges for outpatient setting,40,70,,32,percent of total billed charges,70% of total billed charges for outpatient setting,40,75,,32,percent of total billed charges,75% of total billed charges for outpatient setting,40,75,,32,percent of total billed charges,75% of total billed charges for outpatient setting,40,70,,32,percent of total billed charges,70% of total billed charges for outpatient setting,40,75,,32,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,40,
DISPOSABLE PULSE OX PEDIATRIC,1000201,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
DISPOSABLE PULSE OX ADULT,1000202,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
CATHERIZATION SIMPLE FOLEY,1000208,CDM,450,RC,51702,HCPCS,outpatient,,,102.18,51.09,,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,39.24,38.4,,31.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.24,38.4,,31.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.76,35,,28.608,percent of total billed charges,35% of total billed charges for outpatient setting,79.7,78,,63.76,percent of total billed charges,78% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,84.81,83,,67.848,percent of total billed charges,83% of total billed charges for outpatient setting,51.09,50,,40.872,percent of total billed charges,50% of total billed charges for outpatient setting,51.09,50,,40.872,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.02,39.17,,32.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.76,109.72,
CATHERIZATION  COMPLICATED,1000209,CDM,450,RC,51703,HCPCS,outpatient,,,912,456,,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,350.21,38.4,,280.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.21,38.4,,280.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,684,75,,547.2,percent of total billed charges,75% of total billed charges for outpatient setting,684,75,,547.2,percent of total billed charges,75% of total billed charges for outpatient setting,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,684,75,,547.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.2,35,,255.36,percent of total billed charges,35% of total billed charges for outpatient setting,711.36,78,,569.088,percent of total billed charges,78% of total billed charges for outpatient setting,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,638.4,70,,510.72,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,684,75,,547.2,percent of total billed charges,75% of total billed charges for outpatient setting,756.96,83,,605.568,percent of total billed charges,83% of total billed charges for outpatient setting,456,50,,364.8,percent of total billed charges,50% of total billed charges for outpatient setting,456,50,,364.8,percent of total billed charges,50% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,357.21,39.17,,285.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,756.96,
IM/SQ INJECTION ANY MED,1000210,CDM,450,RC,96372,HCPCS,outpatient,,,309.4,154.7,,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,118.81,38.4,,95.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.81,38.4,,95.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,232.05,75,,185.64,percent of total billed charges,75% of total billed charges for outpatient setting,232.05,75,,185.64,percent of total billed charges,75% of total billed charges for outpatient setting,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,232.05,75,,185.64,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.29,35,,86.632,percent of total billed charges,35% of total billed charges for outpatient setting,241.33,78,,193.064,percent of total billed charges,78% of total billed charges for outpatient setting,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,216.58,70,,173.264,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,232.05,75,,185.64,percent of total billed charges,75% of total billed charges for outpatient setting,256.8,83,,205.44,percent of total billed charges,83% of total billed charges for outpatient setting,154.7,50,,123.76,percent of total billed charges,50% of total billed charges for outpatient setting,154.7,50,,123.76,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.19,39.17,,96.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,256.8,
INJECTION IM THERAPEUTIC,1000211,CDM,450,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM STEROID,1000212,CDM,450,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM TRANQUALIZER,1000213,CDM,450,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
IV INFUSION MED IST HOUR,1000214,CDM,260,RC,96365,HCPCS,outpatient,,,593.33,296.67,,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,227.84,38.4,,182.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,227.84,38.4,,182.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.67,35,,166.136,percent of total billed charges,35% of total billed charges for outpatient setting,462.8,78,,370.24,percent of total billed charges,78% of total billed charges for outpatient setting,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,415.33,70,,332.264,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,445,75,,356,percent of total billed charges,75% of total billed charges for outpatient setting,492.46,83,,393.968,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,232.4,39.17,,185.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,492.46,
IV PUSH,1000215,CDM,260,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,212,
IV PUSH ANY MED,1000216,CDM,260,RC,96374,HCPCS,outpatient,,,339.29,169.65,,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,130.29,38.4,,104.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.29,38.4,,104.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,254.47,75,,203.576,percent of total billed charges,75% of total billed charges for outpatient setting,254.47,75,,203.576,percent of total billed charges,75% of total billed charges for outpatient setting,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,254.47,75,,203.576,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.75,35,,95,percent of total billed charges,35% of total billed charges for outpatient setting,264.65,78,,211.72,percent of total billed charges,78% of total billed charges for outpatient setting,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,237.5,70,,190,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.47,75,,203.576,percent of total billed charges,75% of total billed charges for outpatient setting,281.61,83,,225.288,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.9,39.17,,106.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.75,281.61,
IV TRANQUILIZER,1000217,CDM,260,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,212,
ENDOTRACHAEL INTUBATION,1000219,CDM,450,RC,31500,HCPCS,outpatient,,,369,184.5,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,141.7,38.4,,113.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,141.7,38.4,,113.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.15,35,,103.32,percent of total billed charges,35% of total billed charges for outpatient setting,287.82,78,,230.256,percent of total billed charges,78% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,306.27,83,,245.016,percent of total billed charges,83% of total billed charges for outpatient setting,184.5,50,,147.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.5,50,,147.6,percent of total billed charges,50% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.53,39.17,,115.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.15,306.27,
BURN TREATMENT 1 DEGREE,1000220,CDM,450,RC,16000,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,171.96,
BURN TREATMENT 2 DEGREE SMALL,1000221,CDM,450,RC,16020,HCPCS,outpatient,,,153,76.5,,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,35,,42.84,percent of total billed charges,35% of total billed charges for outpatient setting,119.34,78,,95.472,percent of total billed charges,78% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,126.99,83,,101.592,percent of total billed charges,83% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.93,39.17,,47.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,171.96,
BURN TREATMENT 2 DEGREE MED,1000222,CDM,450,RC,16025,HCPCS,outpatient,,,284,142,,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.06,38.4,,87.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.06,38.4,,87.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.4,35,,79.52,percent of total billed charges,35% of total billed charges for outpatient setting,221.52,78,,177.216,percent of total billed charges,78% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,235.72,83,,188.576,percent of total billed charges,83% of total billed charges for outpatient setting,142,50,,113.6,percent of total billed charges,50% of total billed charges for outpatient setting,142,50,,113.6,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.24,39.17,,88.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.4,235.72,
BURN TREATMENT 2 DEGREE LARGE,1000223,CDM,450,RC,16030,HCPCS,outpatient,,,1029,514.5,,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,395.14,38.4,,316.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,395.14,38.4,,316.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,360.15,35,,288.12,percent of total billed charges,35% of total billed charges for outpatient setting,802.62,78,,642.096,percent of total billed charges,78% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,720.3,70,,576.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,771.75,75,,617.4,percent of total billed charges,75% of total billed charges for outpatient setting,854.07,83,,683.256,percent of total billed charges,83% of total billed charges for outpatient setting,514.5,50,,411.6,percent of total billed charges,50% of total billed charges for outpatient setting,514.5,50,,411.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,403.04,39.17,,322.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,854.07,
PERICARDIOCENTESIS,1000224,CDM,450,RC,33010,HCPCS,outpatient,,,999,499.5,,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,383.62,38.4,,306.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,383.62,38.4,,306.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,749.25,75,,599.4,percent of total billed charges,75% of total billed charges for outpatient setting,749.25,75,,599.4,percent of total billed charges,75% of total billed charges for outpatient setting,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,749.25,75,,599.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,349.65,35,,279.72,percent of total billed charges,35% of total billed charges for outpatient setting,779.22,78,,623.376,percent of total billed charges,78% of total billed charges for outpatient setting,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,699.3,70,,559.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,749.25,75,,599.4,percent of total billed charges,75% of total billed charges for outpatient setting,829.17,83,,663.336,percent of total billed charges,83% of total billed charges for outpatient setting,499.5,50,,399.6,percent of total billed charges,50% of total billed charges for outpatient setting,499.5,50,,399.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,391.29,39.17,,313.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,349.65,829.17,
DISLOCATION SHOULDER W/O ANEST,1000226,CDM,450,RC,23650,HCPCS,outpatient,,,719,359.5,,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,276.1,38.4,,220.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,276.1,38.4,,220.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,539.25,75,,431.4,percent of total billed charges,75% of total billed charges for outpatient setting,539.25,75,,431.4,percent of total billed charges,75% of total billed charges for outpatient setting,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,539.25,75,,431.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,251.65,35,,201.32,percent of total billed charges,35% of total billed charges for outpatient setting,560.82,78,,448.656,percent of total billed charges,78% of total billed charges for outpatient setting,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,503.3,70,,402.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.25,75,,431.4,percent of total billed charges,75% of total billed charges for outpatient setting,596.77,83,,477.416,percent of total billed charges,83% of total billed charges for outpatient setting,359.5,50,,287.6,percent of total billed charges,50% of total billed charges for outpatient setting,359.5,50,,287.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,281.62,39.17,,225.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,596.77,
DISLOCATION SHOULDER W ANESTHE,1000227,CDM,450,RC,23655,HCPCS,outpatient,,,2376,1188,,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,912.38,38.4,,729.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,912.38,38.4,,729.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,831.6,35,,665.28,percent of total billed charges,35% of total billed charges for outpatient setting,1853.28,78,,1482.624,percent of total billed charges,78% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1972.08,83,,1577.664,percent of total billed charges,83% of total billed charges for outpatient setting,1188,50,,950.4,percent of total billed charges,50% of total billed charges for outpatient setting,1188,50,,950.4,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,930.63,39.17,,744.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,831.6,1972.08,
DISLOCATION CLOSED PATELLA W/O,1000228,CDM,450,RC,27560,HCPCS,outpatient,,,829,414.5,,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,318.34,38.4,,254.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,318.34,38.4,,254.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,621.75,75,,497.4,percent of total billed charges,75% of total billed charges for outpatient setting,621.75,75,,497.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,621.75,75,,497.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.15,35,,232.12,percent of total billed charges,35% of total billed charges for outpatient setting,646.62,78,,517.296,percent of total billed charges,78% of total billed charges for outpatient setting,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,580.3,70,,464.24,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,621.75,75,,497.4,percent of total billed charges,75% of total billed charges for outpatient setting,688.07,83,,550.456,percent of total billed charges,83% of total billed charges for outpatient setting,414.5,50,,331.6,percent of total billed charges,50% of total billed charges for outpatient setting,414.5,50,,331.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.71,39.17,,259.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,688.07,
DISLOCATION CLOSED PATELLA W A,1000229,CDM,450,RC,27562,HCPCS,outpatient,,,925,462.5,,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,355.2,38.4,,284.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,355.2,38.4,,284.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,693.75,75,,555,percent of total billed charges,75% of total billed charges for outpatient setting,693.75,75,,555,percent of total billed charges,75% of total billed charges for outpatient setting,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,693.75,75,,555,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,323.75,35,,259,percent of total billed charges,35% of total billed charges for outpatient setting,721.5,78,,577.2,percent of total billed charges,78% of total billed charges for outpatient setting,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,647.5,70,,518,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,693.75,75,,555,percent of total billed charges,75% of total billed charges for outpatient setting,767.75,83,,614.2,percent of total billed charges,83% of total billed charges for outpatient setting,462.5,50,,370,percent of total billed charges,50% of total billed charges for outpatient setting,462.5,50,,370,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,362.3,39.17,,289.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,767.75,
FRACTURE RADIAL HEAD OR NECK N,1000230,CDM,450,RC,24650,HCPCS,outpatient,,,592,296,,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,227.33,38.4,,181.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,227.33,38.4,,181.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,444,75,,355.2,percent of total billed charges,75% of total billed charges for outpatient setting,444,75,,355.2,percent of total billed charges,75% of total billed charges for outpatient setting,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,444,75,,355.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.2,35,,165.76,percent of total billed charges,35% of total billed charges for outpatient setting,461.76,78,,369.408,percent of total billed charges,78% of total billed charges for outpatient setting,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,414.4,70,,331.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,444,75,,355.2,percent of total billed charges,75% of total billed charges for outpatient setting,491.36,83,,393.088,percent of total billed charges,83% of total billed charges for outpatient setting,296,50,,236.8,percent of total billed charges,50% of total billed charges for outpatient setting,296,50,,236.8,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,231.88,39.17,,185.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,491.36,
FRACTURE RADIAL SHAFT CLOSED N,1000231,CDM,450,RC,25500,HCPCS,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,202.56,
FRACTURE ULNA SHAFT CLOSED NO,1000232,CDM,450,RC,25530,HCPCS,outpatient,,,585,292.5,,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,224.64,38.4,,179.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224.64,38.4,,179.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,438.75,75,,351,percent of total billed charges,75% of total billed charges for outpatient setting,438.75,75,,351,percent of total billed charges,75% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,438.75,75,,351,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,204.75,35,,163.8,percent of total billed charges,35% of total billed charges for outpatient setting,456.3,78,,365.04,percent of total billed charges,78% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,409.5,70,,327.6,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,438.75,75,,351,percent of total billed charges,75% of total billed charges for outpatient setting,485.55,83,,388.44,percent of total billed charges,83% of total billed charges for outpatient setting,292.5,50,,234,percent of total billed charges,50% of total billed charges for outpatient setting,292.5,50,,234,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.13,39.17,,183.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,485.55,
FRACTURE RADIAL & ULNA SHAFT C,1000233,CDM,450,RC,25560,HCPCS,outpatient,,,622,311,,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,238.85,38.4,,191.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,238.85,38.4,,191.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,466.5,75,,373.2,percent of total billed charges,75% of total billed charges for outpatient setting,466.5,75,,373.2,percent of total billed charges,75% of total billed charges for outpatient setting,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,466.5,75,,373.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,217.7,35,,174.16,percent of total billed charges,35% of total billed charges for outpatient setting,485.16,78,,388.128,percent of total billed charges,78% of total billed charges for outpatient setting,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,435.4,70,,348.32,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,466.5,75,,373.2,percent of total billed charges,75% of total billed charges for outpatient setting,516.26,83,,413.008,percent of total billed charges,83% of total billed charges for outpatient setting,311,50,,248.8,percent of total billed charges,50% of total billed charges for outpatient setting,311,50,,248.8,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,243.63,39.17,,194.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,516.26,
FRACTURE DISTAL RADIUS NO RED,1000234,CDM,450,RC,25600,HCPCS,outpatient,,,763,381.5,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,292.99,38.4,,234.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,292.99,38.4,,234.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,267.05,35,,213.64,percent of total billed charges,35% of total billed charges for outpatient setting,595.14,78,,476.112,percent of total billed charges,78% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,633.29,83,,506.632,percent of total billed charges,83% of total billed charges for outpatient setting,381.5,50,,305.2,percent of total billed charges,50% of total billed charges for outpatient setting,381.5,50,,305.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,298.85,39.17,,239.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,633.29,
FRACTURE METACARPAL NO RED,1000235,CDM,450,RC,26600,HCPCS,outpatient,,,681,340.5,,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.35,35,,190.68,percent of total billed charges,35% of total billed charges for outpatient setting,531.18,78,,424.944,percent of total billed charges,78% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,565.23,83,,452.184,percent of total billed charges,83% of total billed charges for outpatient setting,340.5,50,,272.4,percent of total billed charges,50% of total billed charges for outpatient setting,340.5,50,,272.4,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,266.73,39.17,,213.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,565.23,
FRACTURE FINGER NO REDUCTION,1000236,CDM,450,RC,26720,HCPCS,outpatient,,,453,226.5,,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,173.95,38.4,,139.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.95,38.4,,139.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.55,35,,126.84,percent of total billed charges,35% of total billed charges for outpatient setting,353.34,78,,282.672,percent of total billed charges,78% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,375.99,83,,300.792,percent of total billed charges,83% of total billed charges for outpatient setting,226.5,50,,181.2,percent of total billed charges,50% of total billed charges for outpatient setting,226.5,50,,181.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177.43,39.17,,141.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.55,375.99,
FRACTURE FINGER WITH REDUCTION,1000237,CDM,450,RC,26725,HCPCS,outpatient,,,754,377,,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,289.54,38.4,,231.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,289.54,38.4,,231.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,565.5,75,,452.4,percent of total billed charges,75% of total billed charges for outpatient setting,565.5,75,,452.4,percent of total billed charges,75% of total billed charges for outpatient setting,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,565.5,75,,452.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,263.9,35,,211.12,percent of total billed charges,35% of total billed charges for outpatient setting,588.12,78,,470.496,percent of total billed charges,78% of total billed charges for outpatient setting,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,527.8,70,,422.24,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.5,75,,452.4,percent of total billed charges,75% of total billed charges for outpatient setting,625.82,83,,500.656,percent of total billed charges,83% of total billed charges for outpatient setting,377,50,,301.6,percent of total billed charges,50% of total billed charges for outpatient setting,377,50,,301.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.33,39.17,,236.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,625.82,
FRACTURE DISTAL FINGER NO REDU,1000238,CDM,450,RC,26750,HCPCS,outpatient,,,453,226.5,,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,173.95,38.4,,139.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.95,38.4,,139.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.55,35,,126.84,percent of total billed charges,35% of total billed charges for outpatient setting,353.34,78,,282.672,percent of total billed charges,78% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,317.1,70,,253.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,339.75,75,,271.8,percent of total billed charges,75% of total billed charges for outpatient setting,375.99,83,,300.792,percent of total billed charges,83% of total billed charges for outpatient setting,226.5,50,,181.2,percent of total billed charges,50% of total billed charges for outpatient setting,226.5,50,,181.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177.43,39.17,,141.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.55,375.99,
FRACTURE DISTAL FINGER OPEN TR,1000239,CDM,450,RC,26765,HCPCS,outpatient,,,4141,2070.5,,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1590.14,38.4,,1272.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1590.14,38.4,,1272.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,3105.75,75,,2484.6,percent of total billed charges,75% of total billed charges for outpatient setting,3105.75,75,,2484.6,percent of total billed charges,75% of total billed charges for outpatient setting,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,3105.75,75,,2484.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1449.35,35,,1159.48,percent of total billed charges,35% of total billed charges for outpatient setting,3229.98,78,,2583.984,percent of total billed charges,78% of total billed charges for outpatient setting,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,2898.7,70,,2318.96,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3105.75,75,,2484.6,percent of total billed charges,75% of total billed charges for outpatient setting,3437.03,83,,2749.624,percent of total billed charges,83% of total billed charges for outpatient setting,2070.5,50,,1656.4,percent of total billed charges,50% of total billed charges for outpatient setting,2070.5,50,,1656.4,percent of total billed charges,50% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1621.94,39.17,,1297.552,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1449.35,3437.03,
FRACTURE FEMORAL SHAFT CLOSED,1000240,CDM,450,RC,27500,HCPCS,outpatient,,,1211,605.5,,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,465.02,38.4,,372.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,465.02,38.4,,372.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,908.25,75,,726.6,percent of total billed charges,75% of total billed charges for outpatient setting,908.25,75,,726.6,percent of total billed charges,75% of total billed charges for outpatient setting,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,908.25,75,,726.6,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,423.85,35,,339.08,percent of total billed charges,35% of total billed charges for outpatient setting,944.58,78,,755.664,percent of total billed charges,78% of total billed charges for outpatient setting,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,847.7,70,,678.16,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,908.25,75,,726.6,percent of total billed charges,75% of total billed charges for outpatient setting,1005.13,83,,804.104,percent of total billed charges,83% of total billed charges for outpatient setting,605.5,50,,484.4,percent of total billed charges,50% of total billed charges for outpatient setting,605.5,50,,484.4,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,474.32,39.17,,379.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,1005.13,
FRACTURE PATELLA CLOSED NO RED,1000241,CDM,450,RC,27520,HCPCS,outpatient,,,358,179,,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,35,,100.24,percent of total billed charges,35% of total billed charges for outpatient setting,279.24,78,,223.392,percent of total billed charges,78% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,297.14,83,,237.712,percent of total billed charges,83% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.22,39.17,,112.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,297.14,
FRACTURE TIBIA CLOSED NO REDCT,1000242,CDM,450,RC,27530,HCPCS,outpatient,,,692,346,,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,265.73,38.4,,212.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,265.73,38.4,,212.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,519,75,,415.2,percent of total billed charges,75% of total billed charges for outpatient setting,519,75,,415.2,percent of total billed charges,75% of total billed charges for outpatient setting,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,519,75,,415.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,242.2,35,,193.76,percent of total billed charges,35% of total billed charges for outpatient setting,539.76,78,,431.808,percent of total billed charges,78% of total billed charges for outpatient setting,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,484.4,70,,387.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,519,75,,415.2,percent of total billed charges,75% of total billed charges for outpatient setting,574.36,83,,459.488,percent of total billed charges,83% of total billed charges for outpatient setting,346,50,,276.8,percent of total billed charges,50% of total billed charges for outpatient setting,346,50,,276.8,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,271.04,39.17,,216.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,574.36,
FRACTURE TIBIAL SHAFT CLOSED N,1000243,CDM,450,RC,27750,HCPCS,outpatient,,,358,179,,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,35,,100.24,percent of total billed charges,35% of total billed charges for outpatient setting,279.24,78,,223.392,percent of total billed charges,78% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,297.14,83,,237.712,percent of total billed charges,83% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.22,39.17,,112.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,297.14,
FRACTURE TIBIAL & FIBULAR SHAF,1000244,CDM,450,RC,27750,HCPCS,outpatient,,,517,258.5,,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,198.53,38.4,,158.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,198.53,38.4,,158.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.95,35,,144.76,percent of total billed charges,35% of total billed charges for outpatient setting,403.26,78,,322.608,percent of total billed charges,78% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,429.11,83,,343.288,percent of total billed charges,83% of total billed charges for outpatient setting,258.5,50,,206.8,percent of total billed charges,50% of total billed charges for outpatient setting,258.5,50,,206.8,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.5,39.17,,162,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.95,429.11,
FRACTURE GREAT TOE CLOSED WITH,1000245,CDM,450,RC,28495,HCPCS,outpatient,,,375,187.5,,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,144,38.4,,115.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144,38.4,,115.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.25,35,,105,percent of total billed charges,35% of total billed charges for outpatient setting,292.5,78,,234,percent of total billed charges,78% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,83,,249,percent of total billed charges,83% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.88,39.17,,117.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.25,311.25,
FRACTURE TOE CLOSED NO REDUCTI,1000246,CDM,450,RC,28510,HCPCS,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,202.56,
I-D SEBACEOUS CYST,1000247,CDM,450,RC,10060,HCPCS,outpatient,,,690,345,,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,241.5,35,,193.2,percent of total billed charges,35% of total billed charges for outpatient setting,538.2,78,,430.56,percent of total billed charges,78% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,572.7,83,,458.16,percent of total billed charges,83% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270.26,39.17,,216.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,572.7,
I-D SMALL ABSCESS,1000248,CDM,450,RC,10060,HCPCS,outpatient,,,582.36,291.18,,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,223.63,38.4,,178.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.63,38.4,,178.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,436.77,75,,349.416,percent of total billed charges,75% of total billed charges for outpatient setting,436.77,75,,349.416,percent of total billed charges,75% of total billed charges for outpatient setting,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,436.77,75,,349.416,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.83,35,,163.064,percent of total billed charges,35% of total billed charges for outpatient setting,454.24,78,,363.392,percent of total billed charges,78% of total billed charges for outpatient setting,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,407.65,70,,326.12,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,436.77,75,,349.416,percent of total billed charges,75% of total billed charges for outpatient setting,483.36,83,,386.688,percent of total billed charges,83% of total billed charges for outpatient setting,291.18,50,,232.944,percent of total billed charges,50% of total billed charges for outpatient setting,291.18,50,,232.944,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228.1,39.17,,182.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,483.36,
I-D PILONIDAL CYST,1000249,CDM,450,RC,10080,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.3,35,,72.24,percent of total billed charges,35% of total billed charges for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.05,39.17,,80.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.3,604.35,
I-D BARTHOLINS GLAND CYST,1000250,CDM,450,RC,56420,HCPCS,outpatient,,,231,115.5,,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,171.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,35,,64.68,percent of total billed charges,35% of total billed charges for outpatient setting,180.18,78,,144.144,percent of total billed charges,78% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,191.73,83,,153.384,percent of total billed charges,83% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.47,39.17,,72.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,191.73,
NOSE BLEED ANTERIOR SIMPLE,1000251,CDM,450,RC,30901,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,143.59,
NOSE BLEED ANTERIOR BILATERIAL,1000252,CDM,450,RC,30901,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,143.59,
NOSE BLEED ANTERIOR COMPLEX,1000253,CDM,450,RC,30903,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,172.64,
NOSE BLEED ANTERIOR COMPLEX BI,1000254,CDM,450,RC,30903,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,172.64,
NOSE BLEED W/PACKS,1000255,CDM,450,RC,30905,HCPCS,outpatient,,,274,137,,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.9,35,,76.72,percent of total billed charges,35% of total billed charges for outpatient setting,213.72,78,,170.976,percent of total billed charges,78% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,227.42,83,,181.936,percent of total billed charges,83% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.32,39.17,,85.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.9,227.42,
EXCISE LESION 0.5 CM TRUNK/LIM,1000256,CDM,450,RC,11400,HCPCS,outpatient,,,657,328.5,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,35,,183.96,percent of total billed charges,35% of total billed charges for outpatient setting,512.46,78,,409.968,percent of total billed charges,78% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,545.31,83,,436.248,percent of total billed charges,83% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.34,39.17,,205.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,604.35,
NAIL EVULSION COMPLETE OR PART,1000257,CDM,450,RC,11730,HCPCS,outpatient,,,893,446.5,,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,342.91,38.4,,274.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,342.91,38.4,,274.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,669.75,75,,535.8,percent of total billed charges,75% of total billed charges for outpatient setting,669.75,75,,535.8,percent of total billed charges,75% of total billed charges for outpatient setting,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,669.75,75,,535.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,312.55,35,,250.04,percent of total billed charges,35% of total billed charges for outpatient setting,696.54,78,,557.232,percent of total billed charges,78% of total billed charges for outpatient setting,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,625.1,70,,500.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,669.75,75,,535.8,percent of total billed charges,75% of total billed charges for outpatient setting,741.19,83,,592.952,percent of total billed charges,83% of total billed charges for outpatient setting,446.5,50,,357.2,percent of total billed charges,50% of total billed charges for outpatient setting,446.5,50,,357.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,349.77,39.17,,279.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,741.19,
EXCISION SIMPLE HEMORRHOID,1000258,CDM,450,RC,46220,HCPCS,outpatient,,,2923,1461.5,,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1023.05,35,,818.44,percent of total billed charges,35% of total billed charges for outpatient setting,2279.94,78,,1823.952,percent of total billed charges,78% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2426.09,83,,1940.872,percent of total billed charges,83% of total billed charges for outpatient setting,1461.5,50,,1169.2,percent of total billed charges,50% of total billed charges for outpatient setting,1461.5,50,,1169.2,percent of total billed charges,50% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1144.88,39.17,,915.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,2426.09,
FRACTURE CLAVICLE NO REDUCTION,1000259,CDM,450,RC,23500,HCPCS,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,202.56,
FRACTURE HUMERAL NECK CLOSED N,1000260,CDM,450,RC,23600,HCPCS,outpatient,,,759,379.5,,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,291.46,38.4,,233.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,291.46,38.4,,233.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,569.25,75,,455.4,percent of total billed charges,75% of total billed charges for outpatient setting,569.25,75,,455.4,percent of total billed charges,75% of total billed charges for outpatient setting,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,569.25,75,,455.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.65,35,,212.52,percent of total billed charges,35% of total billed charges for outpatient setting,592.02,78,,473.616,percent of total billed charges,78% of total billed charges for outpatient setting,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,531.3,70,,425.04,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,569.25,75,,455.4,percent of total billed charges,75% of total billed charges for outpatient setting,629.97,83,,503.976,percent of total billed charges,83% of total billed charges for outpatient setting,379.5,50,,303.6,percent of total billed charges,50% of total billed charges for outpatient setting,379.5,50,,303.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,297.29,39.17,,237.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,629.97,
FRACTURE HUMERAL SHAFT CLOSED,1000261,CDM,450,RC,24500,HCPCS,outpatient,,,808,404,,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,310.27,38.4,,248.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,310.27,38.4,,248.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,282.8,35,,226.24,percent of total billed charges,35% of total billed charges for outpatient setting,630.24,78,,504.192,percent of total billed charges,78% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,565.6,70,,452.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,606,75,,484.8,percent of total billed charges,75% of total billed charges for outpatient setting,670.64,83,,536.512,percent of total billed charges,83% of total billed charges for outpatient setting,404,50,,323.2,percent of total billed charges,50% of total billed charges for outpatient setting,404,50,,323.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,316.48,39.17,,253.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,670.64,
PERIPHERAL NERVE BLOCK,1000262,CDM,450,RC,64450,HCPCS,outpatient,,,1531,765.5,,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,587.9,38.4,,470.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,587.9,38.4,,470.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,1148.25,75,,918.6,percent of total billed charges,75% of total billed charges for outpatient setting,1148.25,75,,918.6,percent of total billed charges,75% of total billed charges for outpatient setting,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,1148.25,75,,918.6,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,535.85,35,,428.68,percent of total billed charges,35% of total billed charges for outpatient setting,1194.18,78,,955.344,percent of total billed charges,78% of total billed charges for outpatient setting,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,1071.7,70,,857.36,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1148.25,75,,918.6,percent of total billed charges,75% of total billed charges for outpatient setting,1270.73,83,,1016.584,percent of total billed charges,83% of total billed charges for outpatient setting,765.5,50,,612.4,percent of total billed charges,50% of total billed charges for outpatient setting,765.5,50,,612.4,percent of total billed charges,50% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,599.66,39.17,,479.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,535.85,1270.73,
REMOVAL FOREIGN BODY SUBCUT SI,1000263,CDM,450,RC,10120,HCPCS,outpatient,,,1189,594.5,,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,456.58,38.4,,365.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,456.58,38.4,,365.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,891.75,75,,713.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.75,75,,713.4,percent of total billed charges,75% of total billed charges for outpatient setting,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,891.75,75,,713.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,416.15,35,,332.92,percent of total billed charges,35% of total billed charges for outpatient setting,927.42,78,,741.936,percent of total billed charges,78% of total billed charges for outpatient setting,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,832.3,70,,665.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,891.75,75,,713.4,percent of total billed charges,75% of total billed charges for outpatient setting,986.87,83,,789.496,percent of total billed charges,83% of total billed charges for outpatient setting,594.5,50,,475.6,percent of total billed charges,50% of total billed charges for outpatient setting,594.5,50,,475.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,465.71,39.17,,372.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,986.87,
REMOVAL FOREIGN BODY MUSCLE SI,1000264,CDM,450,RC,20520,HCPCS,outpatient,,,2048,1024,,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,786.43,38.4,,629.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,786.43,38.4,,629.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1536,75,,1228.8,percent of total billed charges,75% of total billed charges for outpatient setting,1536,75,,1228.8,percent of total billed charges,75% of total billed charges for outpatient setting,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1536,75,,1228.8,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,716.8,35,,573.44,percent of total billed charges,35% of total billed charges for outpatient setting,1597.44,78,,1277.952,percent of total billed charges,78% of total billed charges for outpatient setting,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1433.6,70,,1146.88,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1536,75,,1228.8,percent of total billed charges,75% of total billed charges for outpatient setting,1699.84,83,,1359.872,percent of total billed charges,83% of total billed charges for outpatient setting,1024,50,,819.2,percent of total billed charges,50% of total billed charges for outpatient setting,1024,50,,819.2,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,802.16,39.17,,641.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,716.8,1699.84,
REMOVAL FOREIGN BODY FOOT,1000265,CDM,450,RC,28190,HCPCS,outpatient,,,660,330,,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,253.44,38.4,,202.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,253.44,38.4,,202.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,231,35,,184.8,percent of total billed charges,35% of total billed charges for outpatient setting,514.8,78,,411.84,percent of total billed charges,78% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,547.8,83,,438.24,percent of total billed charges,83% of total billed charges for outpatient setting,330,50,,264,percent of total billed charges,50% of total billed charges for outpatient setting,330,50,,264,percent of total billed charges,50% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.51,39.17,,206.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,231,604.35,
REMOVAL FOREIGN BODY CONJUNCTI,1000266,CDM,450,RC,65205,HCPCS,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56,35,,44.8,percent of total billed charges,35% of total billed charges for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.67,39.17,,50.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56,132.8,
REMOVAL FOREIGN BODY CORNEAL S,1000267,CDM,450,RC,65220,HCPCS,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56,35,,44.8,percent of total billed charges,35% of total billed charges for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.67,39.17,,50.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56,342.25,
REMOVAL FOREIGN BODY EYELID,1000268,CDM,450,RC,67938,HCPCS,outpatient,,,288,144,,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,250.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,35,,80.64,percent of total billed charges,35% of total billed charges for outpatient setting,224.64,78,,179.712,percent of total billed charges,78% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,83,,191.232,percent of total billed charges,83% of total billed charges for outpatient setting,144,50,,115.2,percent of total billed charges,50% of total billed charges for outpatient setting,144,50,,115.2,percent of total billed charges,50% of total billed charges for outpatient setting,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.8,39.17,,90.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,250.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,250.23,
REMOVAL FOREIGN BODY NOSE,1000269,CDM,450,RC,30300,HCPCS,outpatient,,,262,131,,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,100.61,38.4,,80.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.61,38.4,,80.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.7,35,,73.36,percent of total billed charges,35% of total billed charges for outpatient setting,204.36,78,,163.488,percent of total billed charges,78% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,183.4,70,,146.72,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,196.5,75,,157.2,percent of total billed charges,75% of total billed charges for outpatient setting,217.46,83,,173.968,percent of total billed charges,83% of total billed charges for outpatient setting,131,50,,104.8,percent of total billed charges,50% of total billed charges for outpatient setting,131,50,,104.8,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.62,39.17,,82.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.7,217.46,
REMOVAL FOREIGN BODY EAR,1000270,CDM,450,RC,69200,HCPCS,outpatient,,,417,208.5,,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,160.13,38.4,,128.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.13,38.4,,128.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,312.75,75,,250.2,percent of total billed charges,75% of total billed charges for outpatient setting,312.75,75,,250.2,percent of total billed charges,75% of total billed charges for outpatient setting,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,312.75,75,,250.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.95,35,,116.76,percent of total billed charges,35% of total billed charges for outpatient setting,325.26,78,,260.208,percent of total billed charges,78% of total billed charges for outpatient setting,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,291.9,70,,233.52,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,312.75,75,,250.2,percent of total billed charges,75% of total billed charges for outpatient setting,346.11,83,,276.888,percent of total billed charges,83% of total billed charges for outpatient setting,208.5,50,,166.8,percent of total billed charges,50% of total billed charges for outpatient setting,208.5,50,,166.8,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.33,39.17,,130.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,346.11,
REMOVAL IMPACTED CERUMEN,1000271,CDM,450,RC,69210,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.85,92.13,
APPLY SPLINT LONG ARM,1000272,CDM,450,RC,29105,HCPCS,outpatient,,,433,216.5,,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,166.27,38.4,,133.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.27,38.4,,133.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.55,35,,121.24,percent of total billed charges,35% of total billed charges for outpatient setting,337.74,78,,270.192,percent of total billed charges,78% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,359.39,83,,287.512,percent of total billed charges,83% of total billed charges for outpatient setting,216.5,50,,173.2,percent of total billed charges,50% of total billed charges for outpatient setting,216.5,50,,173.2,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.6,39.17,,135.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,359.39,
APPLY SPLINT SHORT ARM,1000273,CDM,450,RC,29125,HCPCS,outpatient,,,848.4,424.2,,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,325.79,38.4,,260.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,325.79,38.4,,260.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,636.3,75,,509.04,percent of total billed charges,75% of total billed charges for outpatient setting,636.3,75,,509.04,percent of total billed charges,75% of total billed charges for outpatient setting,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,636.3,75,,509.04,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.94,35,,237.552,percent of total billed charges,35% of total billed charges for outpatient setting,661.75,78,,529.4,percent of total billed charges,78% of total billed charges for outpatient setting,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,593.88,70,,475.104,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,636.3,75,,509.04,percent of total billed charges,75% of total billed charges for outpatient setting,704.17,83,,563.336,percent of total billed charges,83% of total billed charges for outpatient setting,424.2,50,,339.36,percent of total billed charges,50% of total billed charges for outpatient setting,424.2,50,,339.36,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,332.31,39.17,,265.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,704.17,
APPLY SPLINT FINGER,1000274,CDM,450,RC,29130,HCPCS,outpatient,,,242,121,,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.7,35,,67.76,percent of total billed charges,35% of total billed charges for outpatient setting,188.76,78,,151.008,percent of total billed charges,78% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.86,83,,160.688,percent of total billed charges,83% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.79,39.17,,75.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.7,200.86,
APPLY STRAP SHOULDER,1000275,CDM,450,RC,29240,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,109.72,
APPLY STRAP ELBOW & WRIST,1000276,CDM,450,RC,29260,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,52.54,
STRAP HAND & FINGER,1000277,CDM,450,RC,29280,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.6,96.28,
APPLY SPLINT LONG LEG,1000278,CDM,450,RC,29505,HCPCS,outpatient,,,606,303,,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,232.7,38.4,,186.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,232.7,38.4,,186.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,454.5,75,,363.6,percent of total billed charges,75% of total billed charges for outpatient setting,454.5,75,,363.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,454.5,75,,363.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.1,35,,169.68,percent of total billed charges,35% of total billed charges for outpatient setting,472.68,78,,378.144,percent of total billed charges,78% of total billed charges for outpatient setting,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,424.2,70,,339.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,454.5,75,,363.6,percent of total billed charges,75% of total billed charges for outpatient setting,502.98,83,,402.384,percent of total billed charges,83% of total billed charges for outpatient setting,303,50,,242.4,percent of total billed charges,50% of total billed charges for outpatient setting,303,50,,242.4,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,237.35,39.17,,189.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,502.98,
APPLY SPLINT SHORT LEG,1000279,CDM,450,RC,29515,HCPCS,outpatient,,,763,381.5,,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,292.99,38.4,,234.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,292.99,38.4,,234.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,267.05,35,,213.64,percent of total billed charges,35% of total billed charges for outpatient setting,595.14,78,,476.112,percent of total billed charges,78% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,534.1,70,,427.28,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,572.25,75,,457.8,percent of total billed charges,75% of total billed charges for outpatient setting,633.29,83,,506.632,percent of total billed charges,83% of total billed charges for outpatient setting,381.5,50,,305.2,percent of total billed charges,50% of total billed charges for outpatient setting,381.5,50,,305.2,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,298.85,39.17,,239.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,633.29,
APPLY STRAP KNEE,1000280,CDM,450,RC,29530,HCPCS,outpatient,,,290,145,,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.5,35,,81.2,percent of total billed charges,35% of total billed charges for outpatient setting,226.2,78,,180.96,percent of total billed charges,78% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,240.7,83,,192.56,percent of total billed charges,83% of total billed charges for outpatient setting,145,50,,116,percent of total billed charges,50% of total billed charges for outpatient setting,145,50,,116,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.59,39.17,,90.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.5,240.7,
APPLY STRAP ANKLE,1000281,CDM,450,RC,29540,HCPCS,outpatient,,,204.25,102.13,,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,78.43,38.4,,62.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.43,38.4,,62.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,153.19,75,,122.552,percent of total billed charges,75% of total billed charges for outpatient setting,153.19,75,,122.552,percent of total billed charges,75% of total billed charges for outpatient setting,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,153.19,75,,122.552,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.49,35,,57.192,percent of total billed charges,35% of total billed charges for outpatient setting,159.32,78,,127.456,percent of total billed charges,78% of total billed charges for outpatient setting,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,142.98,70,,114.384,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.19,75,,122.552,percent of total billed charges,75% of total billed charges for outpatient setting,169.53,83,,135.624,percent of total billed charges,83% of total billed charges for outpatient setting,102.13,50,,81.704,percent of total billed charges,50% of total billed charges for outpatient setting,102.13,50,,81.704,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80,39.17,,64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.49,169.53,
APPLY STRAP TOE,1000282,CDM,450,RC,29550,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.6,96.28,
STRAP REMOVAL OR BIVALVING FUL,1000283,CDM,450,RC,29705,HCPCS,outpatient,,,206,103,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.1,35,,57.68,percent of total billed charges,35% of total billed charges for outpatient setting,160.68,78,,128.544,percent of total billed charges,78% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,170.98,83,,136.784,percent of total billed charges,83% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.68,39.17,,64.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.1,230.68,
CATHETER UNILATERAL,1000284,CDM,450,RC,36000,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
CATHETER BILATERAL,1000285,CDM,450,RC,36000,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
VENIPUNCTURE CHILD UNDER 3,1000286,CDM,450,RC,36400,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,36.52,
CVP CATHERIZATION CENTRAL LINE,1000287,CDM,450,RC,36556,HCPCS,outpatient,,,875,437.5,,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,336,38.4,,268.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336,38.4,,268.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.25,35,,245,percent of total billed charges,35% of total billed charges for outpatient setting,682.5,78,,546,percent of total billed charges,78% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,726.25,83,,581,percent of total billed charges,83% of total billed charges for outpatient setting,437.5,50,,350,percent of total billed charges,50% of total billed charges for outpatient setting,437.5,50,,350,percent of total billed charges,50% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.72,39.17,,274.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.25,2737.98,
PLACEMENT OF NEEDLE FOR INTRAO,1000288,CDM,450,RC,36680,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.9,35,,43.12,percent of total billed charges,35% of total billed charges for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.32,39.17,,48.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.9,342.25,
DEBRIEDMENT SIMPLE ABRASIONS,1000289,CDM,450,RC,,,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,73.87,
DEBRIEDMENT SKIN AND SUBCUT TI,1000290,CDM,450,RC,11042,HCPCS,outpatient,,,1557,778.5,,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,597.89,38.4,,478.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,597.89,38.4,,478.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,1167.75,75,,934.2,percent of total billed charges,75% of total billed charges for outpatient setting,1167.75,75,,934.2,percent of total billed charges,75% of total billed charges for outpatient setting,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,1167.75,75,,934.2,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,544.95,35,,435.96,percent of total billed charges,35% of total billed charges for outpatient setting,1214.46,78,,971.568,percent of total billed charges,78% of total billed charges for outpatient setting,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,1089.9,70,,871.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1167.75,75,,934.2,percent of total billed charges,75% of total billed charges for outpatient setting,1292.31,83,,1033.848,percent of total billed charges,83% of total billed charges for outpatient setting,778.5,50,,622.8,percent of total billed charges,50% of total billed charges for outpatient setting,778.5,50,,622.8,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,609.85,39.17,,487.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,1292.31,
SUTURES UP TO 2.5CM SIMPLE FAC,1000291,CDM,450,RC,12011,HCPCS,outpatient,,,172,86,,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.05,38.4,,52.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.05,38.4,,52.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.2,35,,48.16,percent of total billed charges,35% of total billed charges for outpatient setting,134.16,78,,107.328,percent of total billed charges,78% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,142.76,83,,114.208,percent of total billed charges,83% of total billed charges for outpatient setting,86,50,,68.8,percent of total billed charges,50% of total billed charges for outpatient setting,86,50,,68.8,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.37,39.17,,53.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.2,171.96,
SUTURES 2.6 - 7.5 CM SIMPLE SC,1000292,CDM,450,RC,12002,HCPCS,outpatient,,,305.53,152.77,,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,117.32,38.4,,93.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.32,38.4,,93.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,229.15,75,,183.32,percent of total billed charges,75% of total billed charges for outpatient setting,229.15,75,,183.32,percent of total billed charges,75% of total billed charges for outpatient setting,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,229.15,75,,183.32,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.94,35,,85.552,percent of total billed charges,35% of total billed charges for outpatient setting,238.31,78,,190.648,percent of total billed charges,78% of total billed charges for outpatient setting,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,213.87,70,,171.096,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.15,75,,183.32,percent of total billed charges,75% of total billed charges for outpatient setting,253.59,83,,202.872,percent of total billed charges,83% of total billed charges for outpatient setting,152.77,50,,122.216,percent of total billed charges,50% of total billed charges for outpatient setting,152.77,50,,122.216,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.67,39.17,,95.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.94,253.59,
SUTURES 7.6 - 12.5 CM SIMPLE S,1000293,CDM,450,RC,12004,HCPCS,outpatient,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.5,171.96,
SUTURES 12.6 - 20.00 CM SIMPLE,1000294,CDM,450,RC,12005,HCPCS,outpatient,,,362,181,,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,139.01,38.4,,111.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.01,38.4,,111.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,271.5,75,,217.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.5,75,,217.2,percent of total billed charges,75% of total billed charges for outpatient setting,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,271.5,75,,217.2,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.7,35,,101.36,percent of total billed charges,35% of total billed charges for outpatient setting,282.36,78,,225.888,percent of total billed charges,78% of total billed charges for outpatient setting,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,253.4,70,,202.72,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,271.5,75,,217.2,percent of total billed charges,75% of total billed charges for outpatient setting,300.46,83,,240.368,percent of total billed charges,83% of total billed charges for outpatient setting,181,50,,144.8,percent of total billed charges,50% of total billed charges for outpatient setting,181,50,,144.8,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.79,39.17,,113.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.7,342.51,
SUTURES 20.1 - 30.00 CM SIMPLE,1000295,CDM,450,RC,12006,HCPCS,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,342.51,
SUTURES OVER 30.0CM SIMPLE SCA,1000296,CDM,450,RC,12007,HCPCS,outpatient,,,380,190,,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,145.92,38.4,,116.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.92,38.4,,116.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,285,75,,228,percent of total billed charges,75% of total billed charges for outpatient setting,285,75,,228,percent of total billed charges,75% of total billed charges for outpatient setting,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,285,75,,228,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133,35,,106.4,percent of total billed charges,35% of total billed charges for outpatient setting,296.4,78,,237.12,percent of total billed charges,78% of total billed charges for outpatient setting,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,266,70,,212.8,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285,75,,228,percent of total billed charges,75% of total billed charges for outpatient setting,315.4,83,,252.32,percent of total billed charges,83% of total billed charges for outpatient setting,190,50,,152,percent of total billed charges,50% of total billed charges for outpatient setting,190,50,,152,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,148.84,39.17,,119.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133,315.4,
SUTURES UP TO 2.5CM SIMPLE  FA,1000297,CDM,450,RC,12011,HCPCS,outpatient,,,506.8,253.4,,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,194.61,38.4,,155.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.61,38.4,,155.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,380.1,75,,304.08,percent of total billed charges,75% of total billed charges for outpatient setting,380.1,75,,304.08,percent of total billed charges,75% of total billed charges for outpatient setting,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,380.1,75,,304.08,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177.38,35,,141.904,percent of total billed charges,35% of total billed charges for outpatient setting,395.3,78,,316.24,percent of total billed charges,78% of total billed charges for outpatient setting,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,354.76,70,,283.808,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.1,75,,304.08,percent of total billed charges,75% of total billed charges for outpatient setting,420.64,83,,336.512,percent of total billed charges,83% of total billed charges for outpatient setting,253.4,50,,202.72,percent of total billed charges,50% of total billed charges for outpatient setting,253.4,50,,202.72,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,198.5,39.17,,158.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,420.64,
SUTURES 2.6 - 7.5 CM SIMPLE FA,1000298,CDM,450,RC,12013,HCPCS,outpatient,,,539,269.5,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,206.98,38.4,,165.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.98,38.4,,165.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.65,35,,150.92,percent of total billed charges,35% of total billed charges for outpatient setting,420.42,78,,336.336,percent of total billed charges,78% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,447.37,83,,357.896,percent of total billed charges,83% of total billed charges for outpatient setting,269.5,50,,215.6,percent of total billed charges,50% of total billed charges for outpatient setting,269.5,50,,215.6,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,211.12,39.17,,168.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,447.37,
SUTURES 7.6 - 12.5 CM SIMPLE F,1000299,CDM,450,RC,12014,HCPCS,outpatient,,,539,269.5,,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,206.98,38.4,,165.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.98,38.4,,165.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.65,35,,150.92,percent of total billed charges,35% of total billed charges for outpatient setting,420.42,78,,336.336,percent of total billed charges,78% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,377.3,70,,301.84,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,404.25,75,,323.4,percent of total billed charges,75% of total billed charges for outpatient setting,447.37,83,,357.896,percent of total billed charges,83% of total billed charges for outpatient setting,269.5,50,,215.6,percent of total billed charges,50% of total billed charges for outpatient setting,269.5,50,,215.6,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,211.12,39.17,,168.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,447.37,
SUTURES 12.6 - 20.00 CM SIMPLE,1000301,CDM,450,RC,12015,HCPCS,outpatient,,,245,122.5,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,94.08,38.4,,75.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.08,38.4,,75.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.75,35,,68.6,percent of total billed charges,35% of total billed charges for outpatient setting,191.1,78,,152.88,percent of total billed charges,78% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,203.35,83,,162.68,percent of total billed charges,83% of total billed charges for outpatient setting,122.5,50,,98,percent of total billed charges,50% of total billed charges for outpatient setting,122.5,50,,98,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.96,39.17,,76.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.75,203.35,
SUTURES 20.1 - 30.00 CM SIMPLE,1000302,CDM,450,RC,12016,HCPCS,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.9,342.51,
SUTURES OVER 30.0CM SIMPLE FAC,1000303,CDM,450,RC,12017,HCPCS,outpatient,,,406,203,,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,155.9,38.4,,124.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.9,38.4,,124.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,75,,243.6,percent of total billed charges,75% of total billed charges for outpatient setting,304.5,75,,243.6,percent of total billed charges,75% of total billed charges for outpatient setting,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,75,,243.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.1,35,,113.68,percent of total billed charges,35% of total billed charges for outpatient setting,316.68,78,,253.344,percent of total billed charges,78% of total billed charges for outpatient setting,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,284.2,70,,227.36,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,304.5,75,,243.6,percent of total billed charges,75% of total billed charges for outpatient setting,336.98,83,,269.584,percent of total billed charges,83% of total billed charges for outpatient setting,203,50,,162.4,percent of total billed charges,50% of total billed charges for outpatient setting,203,50,,162.4,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.02,39.17,,127.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.1,342.51,
CHEST TUBE INSERTION,1000304,CDM,450,RC,32551,HCPCS,outpatient,,,500,250,,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,192,38.4,,153.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192,38.4,,153.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,175,35,,140,percent of total billed charges,35% of total billed charges for outpatient setting,390,78,,312,percent of total billed charges,78% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,415,83,,332,percent of total billed charges,83% of total billed charges for outpatient setting,250,50,,200,percent of total billed charges,50% of total billed charges for outpatient setting,250,50,,200,percent of total billed charges,50% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.84,39.17,,156.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,175,1375.68,
TRANSFUSION BLOOD,1000305,CDM,450,RC,36430,HCPCS,outpatient,,,411,205.5,,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.82,38.4,,126.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.82,38.4,,126.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,308.25,75,,246.6,percent of total billed charges,75% of total billed charges for outpatient setting,308.25,75,,246.6,percent of total billed charges,75% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,308.25,75,,246.6,percent of total billed charges,75% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.85,35,,115.08,percent of total billed charges,35% of total billed charges for outpatient setting,320.58,78,,256.464,percent of total billed charges,78% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,287.7,70,,230.16,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.25,75,,246.6,percent of total billed charges,75% of total billed charges for outpatient setting,341.13,83,,272.904,percent of total billed charges,83% of total billed charges for outpatient setting,205.5,50,,164.4,percent of total billed charges,50% of total billed charges for outpatient setting,205.5,50,,164.4,percent of total billed charges,50% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.98,39.17,,128.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.85,372.88,
GASTROSTOMY TUBE CHANGE,1000307,CDM,450,RC,43762,HCPCS,outpatient,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.5,212.29,
BLADDER IRRIGATION SIMPLE,1000308,CDM,450,RC,51700,HCPCS,outpatient,,,218,109,,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.3,35,,61.04,percent of total billed charges,35% of total billed charges for outpatient setting,170.04,78,,136.032,percent of total billed charges,78% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.94,83,,144.752,percent of total billed charges,83% of total billed charges for outpatient setting,109,50,,87.2,percent of total billed charges,50% of total billed charges for outpatient setting,109,50,,87.2,percent of total billed charges,50% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.38,39.17,,68.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.3,212.29,
LUMBAR PUNCTURE,1000309,CDM,450,RC,62270,HCPCS,outpatient,,,365,182.5,,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,140.16,38.4,,112.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.16,38.4,,112.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,273.75,75,,219,percent of total billed charges,75% of total billed charges for outpatient setting,273.75,75,,219,percent of total billed charges,75% of total billed charges for outpatient setting,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,273.75,75,,219,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.75,35,,102.2,percent of total billed charges,35% of total billed charges for outpatient setting,284.7,78,,227.76,percent of total billed charges,78% of total billed charges for outpatient setting,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,255.5,70,,204.4,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.75,75,,219,percent of total billed charges,75% of total billed charges for outpatient setting,302.95,83,,242.36,percent of total billed charges,83% of total billed charges for outpatient setting,182.5,50,,146,percent of total billed charges,50% of total billed charges for outpatient setting,182.5,50,,146,percent of total billed charges,50% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.96,39.17,,114.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.75,594.02,
GASTRIC INTUBATION LAVAGE FOR,1000310,CDM,450,RC,91105,HCPCS,outpatient,,,69,34.5,,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.15,35,,19.32,percent of total billed charges,35% of total billed charges for outpatient setting,53.82,78,,43.056,percent of total billed charges,78% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,57.27,83,,45.816,percent of total billed charges,83% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.03,39.17,,21.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.15,57.27,
BONE MARROW BIOPSY,1000312,CDM,360,RC,38221,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
EVALUATION/ MANAGEMENT LEVEL 1,1000313,CDM,450,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
EVALUATION/ MANAGEMENT LEVEL 2,1000314,CDM,450,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,106.24,
EVALUATION/ MANAGEMENT LEVEL 3,1000315,CDM,450,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
EVALUATION/ MANAGEMENT LEVEL 4,1000316,CDM,450,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
EVALUATION/ MANAGEMENT LEVEL 5,1000317,CDM,450,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
EVALUATION/ MANAGEMENT LEVEL 1,1000319,CDM,450,RC,99211,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.9,35,,43.12,percent of total billed charges,35% of total billed charges for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.32,39.17,,48.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.9,127.82,
EVALUATION/ MANAGEMENT LEVEL 2,1000320,CDM,450,RC,99212,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
EVALUATION/ MANAGEMENT LEVEL 3,1000321,CDM,450,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
EVALUATION/ MANAGEMENT LEVEL 4,1000322,CDM,450,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
EVALUATION/ MANAGEMENT LEVEL 5,1000323,CDM,450,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
INJECTION VACCINE/TOXOID/RABIE,1000324,CDM,260,RC,90471,HCPCS,outpatient,,,76.8,38.4,,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.49,38.4,,23.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.49,38.4,,23.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,57.6,75,,46.08,percent of total billed charges,75% of total billed charges for outpatient setting,57.6,75,,46.08,percent of total billed charges,75% of total billed charges for outpatient setting,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,57.6,75,,46.08,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.88,35,,21.504,percent of total billed charges,35% of total billed charges for outpatient setting,59.9,78,,47.92,percent of total billed charges,78% of total billed charges for outpatient setting,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,53.76,70,,43.008,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.6,75,,46.08,percent of total billed charges,75% of total billed charges for outpatient setting,63.74,83,,50.992,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.08,39.17,,24.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.88,212,
BONE BIOPSY,1000325,CDM,360,RC,20220,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
INJECTION ADM EACH ADD'L RABIE,1000326,CDM,260,RC,90472,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,212,
IV INFUSION MED EACH ADD L HOU,1000327,CDM,260,RC,96366,HCPCS,outpatient,,,38.82,19.41,,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.91,38.4,,11.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.91,38.4,,11.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.59,35,,10.872,percent of total billed charges,35% of total billed charges for outpatient setting,30.28,78,,24.224,percent of total billed charges,78% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,32.22,83,,25.776,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.21,39.17,,12.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.59,212,
BONE MARROW ASPIRATE,1000328,CDM,360,RC,38220,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
ER CRITICAL CARE,1000329,CDM,450,RC,99291,HCPCS,outpatient,,,1103.11,551.56,,772.18,70,,617.744,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,423.59,38.4,,338.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,423.59,38.4,,338.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1103.11,70,,882.488,percent of total billed charges,70% of total billed charges for outpatient setting,1103.11,70,,882.488,percent of total billed charges,70% of total billed charges for outpatient setting,1103.11,70,,882.488,percent of total billed charges,70% of total billed charges for outpatient setting,1103.11,75,,882.488,percent of total billed charges,75% of total billed charges for outpatient setting,1103.11,75,,882.488,percent of total billed charges,75% of total billed charges for outpatient setting,772.18,70,,617.744,percent of total billed charges,70% of total billed charges for outpatient setting,1103.11,75,,882.488,percent of total billed charges,75% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.09,35,,308.872,percent of total billed charges,35% of total billed charges for outpatient setting,860.43,78,,688.344,percent of total billed charges,78% of total billed charges for outpatient setting,772.18,70,,617.744,percent of total billed charges,70% of total billed charges for outpatient setting,772.18,70,,617.744,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,827.33,75,,661.864,percent of total billed charges,75% of total billed charges for outpatient setting,915.58,83,,732.464,percent of total billed charges,83% of total billed charges for outpatient setting,551.56,50,,441.248,percent of total billed charges,50% of total billed charges for outpatient setting,551.56,50,,441.248,percent of total billed charges,50% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,432.06,39.17,,345.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.09,1103.11,
INJECTION TOXOID,1000330,CDM,260,RC,90471,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,212,
SUTURES 7.6 - 12.5 CM COMPLEX,1000331,CDM,450,RC,13121,HCPCS,outpatient,,,685,342.5,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,263.04,38.4,,210.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,263.04,38.4,,210.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.75,35,,191.8,percent of total billed charges,35% of total billed charges for outpatient setting,534.3,78,,427.44,percent of total billed charges,78% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,568.55,83,,454.84,percent of total billed charges,83% of total billed charges for outpatient setting,342.5,50,,274,percent of total billed charges,50% of total billed charges for outpatient setting,342.5,50,,274,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.3,39.17,,214.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.75,568.55,
SUTURES ADD'L 5 CM COMPLEX,1000332,CDM,450,RC,13122,HCPCS,outpatient,,,268,134,,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.91,38.4,,82.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.91,38.4,,82.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.8,35,,75.04,percent of total billed charges,35% of total billed charges for outpatient setting,209.04,78,,167.232,percent of total billed charges,78% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,222.44,83,,177.952,percent of total billed charges,83% of total billed charges for outpatient setting,134,50,,107.2,percent of total billed charges,50% of total billed charges for outpatient setting,134,50,,107.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.97,39.17,,83.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,93.8,222.44,
DISLOCATION OF ELBOW,1000334,CDM,450,RC,24600,HCPCS,outpatient,,,358,179,,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.47,38.4,,109.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,35,,100.24,percent of total billed charges,35% of total billed charges for outpatient setting,279.24,78,,223.392,percent of total billed charges,78% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,250.6,70,,200.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.5,75,,214.8,percent of total billed charges,75% of total billed charges for outpatient setting,297.14,83,,237.712,percent of total billed charges,83% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,179,50,,143.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.22,39.17,,112.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.3,297.14,
EXCISION OF EXTERNAL THROMBOTI,1000335,CDM,450,RC,46320,HCPCS,outpatient,,,2923,1461.5,,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1122.43,38.4,,897.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1023.05,35,,818.44,percent of total billed charges,35% of total billed charges for outpatient setting,2279.94,78,,1823.952,percent of total billed charges,78% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,2046.1,70,,1636.88,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2192.25,75,,1753.8,percent of total billed charges,75% of total billed charges for outpatient setting,2426.09,83,,1940.872,percent of total billed charges,83% of total billed charges for outpatient setting,1461.5,50,,1169.2,percent of total billed charges,50% of total billed charges for outpatient setting,1461.5,50,,1169.2,percent of total billed charges,50% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1144.88,39.17,,915.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,2426.09,
PERI LAVAGE,1000337,CDM,360,RC,49080,HCPCS,outpatient,,,206,103,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.1,35,,57.68,percent of total billed charges,35% of total billed charges for outpatient setting,160.68,78,,128.544,percent of total billed charges,78% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,170.98,83,,136.784,percent of total billed charges,83% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.68,39.17,,64.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.1,170.98,
EXPLORATION - PENETRATING WOUN,1000338,CDM,450,RC,20102,HCPCS,outpatient,,,2822,1411,,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1083.65,38.4,,866.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1083.65,38.4,,866.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.7,35,,790.16,percent of total billed charges,35% of total billed charges for outpatient setting,2201.16,78,,1760.928,percent of total billed charges,78% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,2342.26,83,,1873.808,percent of total billed charges,83% of total billed charges for outpatient setting,1411,50,,1128.8,percent of total billed charges,50% of total billed charges for outpatient setting,1411,50,,1128.8,percent of total billed charges,50% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1105.32,39.17,,884.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.7,2342.26,
CONSCIOUS SEDATION  IM/IV/INHA,1000339,CDM,450,RC,99152,HCPCS,outpatient,,,721,360.5,,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.35,35,,201.88,percent of total billed charges,35% of total billed charges for outpatient setting,562.38,78,,449.904,percent of total billed charges,78% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,598.43,83,,478.744,percent of total billed charges,83% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.4,39.17,,225.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,252.35,598.43,
CONSCIOUS SEDATION ORAL/RECTAL,1000340,CDM,450,RC,,,outpatient,,,721,360.5,,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,276.86,38.4,,221.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.35,35,,201.88,percent of total billed charges,35% of total billed charges for outpatient setting,562.38,78,,449.904,percent of total billed charges,78% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,504.7,70,,403.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.75,75,,432.6,percent of total billed charges,75% of total billed charges for outpatient setting,598.43,83,,478.744,percent of total billed charges,83% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,360.5,50,,288.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,282.4,39.17,,225.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,252.35,598.43,
DISLOCATION OF ELBOW @ ANESTHE,1000442,CDM,450,RC,24605,HCPCS,outpatient,,,2376,1188,,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,912.38,38.4,,729.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,912.38,38.4,,729.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,831.6,35,,665.28,percent of total billed charges,35% of total billed charges for outpatient setting,1853.28,78,,1482.624,percent of total billed charges,78% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1663.2,70,,1330.56,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1782,75,,1425.6,percent of total billed charges,75% of total billed charges for outpatient setting,1972.08,83,,1577.664,percent of total billed charges,83% of total billed charges for outpatient setting,1188,50,,950.4,percent of total billed charges,50% of total billed charges for outpatient setting,1188,50,,950.4,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,930.63,39.17,,744.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,831.6,1972.08,
ASPIRATION ABSCESS CYST,1000443,CDM,450,RC,10160,HCPCS,outpatient,,,241,120.5,,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,92.54,38.4,,74.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.54,38.4,,74.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.35,35,,67.48,percent of total billed charges,35% of total billed charges for outpatient setting,187.98,78,,150.384,percent of total billed charges,78% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,168.7,70,,134.96,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.75,75,,144.6,percent of total billed charges,75% of total billed charges for outpatient setting,200.03,83,,160.024,percent of total billed charges,83% of total billed charges for outpatient setting,120.5,50,,96.4,percent of total billed charges,50% of total billed charges for outpatient setting,120.5,50,,96.4,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.39,39.17,,75.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.35,342.51,
INJECTION KNEE ARTHROGRAM,1000444,CDM,450,RC,27370,HCPCS,outpatient,,,445,222.5,,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.75,35,,124.6,percent of total billed charges,35% of total billed charges for outpatient setting,347.1,78,,277.68,percent of total billed charges,78% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,369.35,83,,295.48,percent of total billed charges,83% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.3,39.17,,139.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,155.75,369.35,
EVACUATION SUBUNGAL HEMATOMA,1000445,CDM,450,RC,11740,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,109.72,
ACCESS PORT A CATH DRAW BLOOD,1000446,CDM,450,RC,36591,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,109.72,
PACEMAKAER INSERTION,1000447,CDM,450,RC,,,outpatient,,,515,257.5,,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.25,35,,144.2,percent of total billed charges,35% of total billed charges for outpatient setting,401.7,78,,321.36,percent of total billed charges,78% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,427.45,83,,341.96,percent of total billed charges,83% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.72,39.17,,161.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,180.25,427.45,
SUTURES UP TO 2.5CM SIMPLE SCA,1000448,CDM,450,RC,12001,HCPCS,outpatient,,,454.92,227.46,,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,174.69,38.4,,139.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,174.69,38.4,,139.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,341.19,75,,272.952,percent of total billed charges,75% of total billed charges for outpatient setting,341.19,75,,272.952,percent of total billed charges,75% of total billed charges for outpatient setting,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,341.19,75,,272.952,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.22,35,,127.376,percent of total billed charges,35% of total billed charges for outpatient setting,354.84,78,,283.872,percent of total billed charges,78% of total billed charges for outpatient setting,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,318.44,70,,254.752,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,341.19,75,,272.952,percent of total billed charges,75% of total billed charges for outpatient setting,377.58,83,,302.064,percent of total billed charges,83% of total billed charges for outpatient setting,227.46,50,,181.968,percent of total billed charges,50% of total billed charges for outpatient setting,227.46,50,,181.968,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.18,39.17,,142.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.22,377.58,
DISLOCATION OF FINGER,1000449,CDM,450,RC,26670,HCPCS,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,111.5,50,,89.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,202.56,
SUTURES INTERMEDIATE 2.6CM - 7,1000450,CDM,450,RC,12032,HCPCS,outpatient,,,493,246.5,,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,189.31,38.4,,151.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.31,38.4,,151.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,369.75,75,,295.8,percent of total billed charges,75% of total billed charges for outpatient setting,369.75,75,,295.8,percent of total billed charges,75% of total billed charges for outpatient setting,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,369.75,75,,295.8,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,172.55,35,,138.04,percent of total billed charges,35% of total billed charges for outpatient setting,384.54,78,,307.632,percent of total billed charges,78% of total billed charges for outpatient setting,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,345.1,70,,276.08,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,369.75,75,,295.8,percent of total billed charges,75% of total billed charges for outpatient setting,409.19,83,,327.352,percent of total billed charges,83% of total billed charges for outpatient setting,246.5,50,,197.2,percent of total billed charges,50% of total billed charges for outpatient setting,246.5,50,,197.2,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,193.1,39.17,,154.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,172.55,409.19,
PERIRECTAL ABSCESS,1000451,CDM,450,RC,46050,HCPCS,outpatient,,,487,243.5,,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.01,38.4,,149.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.01,38.4,,149.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.45,35,,136.36,percent of total billed charges,35% of total billed charges for outpatient setting,379.86,78,,303.888,percent of total billed charges,78% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,404.21,83,,323.368,percent of total billed charges,83% of total billed charges for outpatient setting,243.5,50,,194.8,percent of total billed charges,50% of total billed charges for outpatient setting,243.5,50,,194.8,percent of total billed charges,50% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,39.17,,152.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.45,785.07,
I & D ABSCESS COMPLICATED,1000452,CDM,450,RC,10061,HCPCS,outpatient,,,1042,521,,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,400.13,38.4,,320.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400.13,38.4,,320.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,781.5,75,,625.2,percent of total billed charges,75% of total billed charges for outpatient setting,781.5,75,,625.2,percent of total billed charges,75% of total billed charges for outpatient setting,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,781.5,75,,625.2,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,364.7,35,,291.76,percent of total billed charges,35% of total billed charges for outpatient setting,812.76,78,,650.208,percent of total billed charges,78% of total billed charges for outpatient setting,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,729.4,70,,583.52,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,781.5,75,,625.2,percent of total billed charges,75% of total billed charges for outpatient setting,864.86,83,,691.888,percent of total billed charges,83% of total billed charges for outpatient setting,521,50,,416.8,percent of total billed charges,50% of total billed charges for outpatient setting,521,50,,416.8,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.13,39.17,,326.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,864.86,
ASPIRATION/INJECTION KNEE,1000453,CDM,450,RC,20610,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,254.41,
IV INFUSION HYDRATION,1000454,CDM,260,RC,96360,HCPCS,outpatient,,,533.41,266.71,,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,204.83,38.4,,163.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,204.83,38.4,,163.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,400.06,75,,320.048,percent of total billed charges,75% of total billed charges for outpatient setting,400.06,75,,320.048,percent of total billed charges,75% of total billed charges for outpatient setting,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,400.06,75,,320.048,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,186.69,35,,149.352,percent of total billed charges,35% of total billed charges for outpatient setting,416.06,78,,332.848,percent of total billed charges,78% of total billed charges for outpatient setting,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,373.39,70,,298.712,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,400.06,75,,320.048,percent of total billed charges,75% of total billed charges for outpatient setting,442.73,83,,354.184,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.93,39.17,,167.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,442.73,
IV INFUSION HYDRATION EACH ADD,1000455,CDM,260,RC,96361,HCPCS,outpatient,,,140.95,70.48,,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,54.12,38.4,,43.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.12,38.4,,43.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.33,35,,39.464,percent of total billed charges,35% of total billed charges for outpatient setting,109.94,78,,87.952,percent of total billed charges,78% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,116.99,83,,93.592,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.2,39.17,,44.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,212,
IN/OUT CATH,1000456,CDM,450,RC,51701,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,101.5,50,,81.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.05,168.49,
IV PUSH SAME MED AFTER 30 MIN,1000457,CDM,260,RC,96376,HCPCS,outpatient,,,212.8,106.4,,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.72,38.4,,65.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.72,38.4,,65.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,159.6,75,,127.68,percent of total billed charges,75% of total billed charges for outpatient setting,159.6,75,,127.68,percent of total billed charges,75% of total billed charges for outpatient setting,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,159.6,75,,127.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.48,35,,59.584,percent of total billed charges,35% of total billed charges for outpatient setting,165.98,78,,132.784,percent of total billed charges,78% of total billed charges for outpatient setting,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,148.96,70,,119.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.6,75,,127.68,percent of total billed charges,75% of total billed charges for outpatient setting,176.62,83,,141.296,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.35,39.17,,66.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,74.48,212,
ADDITIONAL IV PUSH NEW MED,1000458,CDM,260,RC,96375,HCPCS,outpatient,,,224.5,112.25,,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,86.21,38.4,,68.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.21,38.4,,68.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,168.38,75,,134.704,percent of total billed charges,75% of total billed charges for outpatient setting,168.38,75,,134.704,percent of total billed charges,75% of total billed charges for outpatient setting,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,168.38,75,,134.704,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.58,35,,62.864,percent of total billed charges,35% of total billed charges for outpatient setting,175.11,78,,140.088,percent of total billed charges,78% of total billed charges for outpatient setting,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,157.15,70,,125.72,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,168.38,75,,134.704,percent of total billed charges,75% of total billed charges for outpatient setting,186.34,83,,149.072,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.93,39.17,,70.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,212,
INJECTION IV STEROID,1000459,CDM,260,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,212,
TRIGGER POINT INJECTION,1000460,CDM,360,RC,20553,HCPCS,outpatient,,,416,208,,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,159.74,38.4,,127.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,159.74,38.4,,127.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,312,75,,249.6,percent of total billed charges,75% of total billed charges for outpatient setting,312,75,,249.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,312,75,,249.6,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.6,35,,116.48,percent of total billed charges,35% of total billed charges for outpatient setting,324.48,78,,259.584,percent of total billed charges,78% of total billed charges for outpatient setting,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,291.2,70,,232.96,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,312,75,,249.6,percent of total billed charges,75% of total billed charges for outpatient setting,345.28,83,,276.224,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162.93,39.17,,130.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.6,659,
ASPIRATION/INJECTION ELBOW WRI,1000461,CDM,760,RC,20605,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,254.41,
CONSCIOUS SEDATION  ADDDITIONA,1000462,CDM,450,RC,99145,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.45,138.61,
OCCULT BLOOD,1000463,CDM,300,RC,82272,HCPCS,outpatient,,,16.8,8.4,,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,13.1,78,,10.48,percent of total billed charges,78% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,11.76,70,,9.408,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.6,75,,10.08,percent of total billed charges,75% of total billed charges for outpatient setting,13.94,83,,11.152,percent of total billed charges,83% of total billed charges for outpatient setting,8.4,50,,6.72,percent of total billed charges,50% of total billed charges for outpatient setting,8.4,50,,6.72,percent of total billed charges,50% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,13.94,
CRITICAL CARE ADDITIONAL 30 MI,1000464,CDM,450,RC,99292,HCPCS,outpatient,,,287,143.5,,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.45,35,,80.36,percent of total billed charges,35% of total billed charges for outpatient setting,223.86,78,,179.088,percent of total billed charges,78% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,238.21,83,,190.568,percent of total billed charges,83% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.41,39.17,,89.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,100.45,238.21,
CPR,1000465,CDM,450,RC,92950,HCPCS,outpatient,,,485,242.5,,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186.24,38.4,,148.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,35,,135.8,percent of total billed charges,35% of total billed charges for outpatient setting,378.3,78,,302.64,percent of total billed charges,78% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,339.5,70,,271.6,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,363.75,75,,291,percent of total billed charges,75% of total billed charges for outpatient setting,402.55,83,,322.04,percent of total billed charges,83% of total billed charges for outpatient setting,242.5,50,,194,percent of total billed charges,50% of total billed charges for outpatient setting,242.5,50,,194,percent of total billed charges,50% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,189.96,39.17,,151.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.75,402.55,
INTERNAL PACEMAKER INSERTION,1000466,CDM,450,RC,92961,HCPCS,outpatient,,,909,454.5,,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,349.06,38.4,,279.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,349.06,38.4,,279.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,681.75,75,,545.4,percent of total billed charges,75% of total billed charges for outpatient setting,681.75,75,,545.4,percent of total billed charges,75% of total billed charges for outpatient setting,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,681.75,75,,545.4,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.15,35,,254.52,percent of total billed charges,35% of total billed charges for outpatient setting,709.02,78,,567.216,percent of total billed charges,78% of total billed charges for outpatient setting,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,636.3,70,,509.04,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,681.75,75,,545.4,percent of total billed charges,75% of total billed charges for outpatient setting,754.47,83,,603.576,percent of total billed charges,83% of total billed charges for outpatient setting,454.5,50,,363.6,percent of total billed charges,50% of total billed charges for outpatient setting,454.5,50,,363.6,percent of total billed charges,50% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,356.04,39.17,,284.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.15,754.47,
SEQUENTIAL INFUSION UP TO 1 HR,1000467,CDM,450,RC,96367,HCPCS,outpatient,,,63.3,31.65,,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.31,38.4,,19.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.31,38.4,,19.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,47.48,75,,37.984,percent of total billed charges,75% of total billed charges for outpatient setting,47.48,75,,37.984,percent of total billed charges,75% of total billed charges for outpatient setting,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,47.48,75,,37.984,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,35,,17.728,percent of total billed charges,35% of total billed charges for outpatient setting,49.37,78,,39.496,percent of total billed charges,78% of total billed charges for outpatient setting,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,44.31,70,,35.448,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.48,75,,37.984,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,83,,42.032,percent of total billed charges,83% of total billed charges for outpatient setting,31.65,50,,25.32,percent of total billed charges,50% of total billed charges for outpatient setting,31.65,50,,25.32,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.8,39.17,,19.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,60.51,
CONCURRENT INFUSION,1000468,CDM,761,RC,96368,HCPCS,outpatient,,,42.2,21.1,,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.2,38.4,,12.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.2,38.4,,12.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.77,35,,11.816,percent of total billed charges,35% of total billed charges for outpatient setting,32.92,78,,26.336,percent of total billed charges,78% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,35.03,83,,28.024,percent of total billed charges,83% of total billed charges for outpatient setting,21.1,50,,16.88,percent of total billed charges,50% of total billed charges for outpatient setting,21.1,50,,16.88,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.52,39.17,,13.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.77,35.03,
CENTRAL LINE BLOOD DRAW,1000469,CDM,450,RC,36592,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,109.72,
CALCANEAL FRACTURE CLOSED TREA,1000470,CDM,450,RC,28400,HCPCS,outpatient,,,563,281.5,,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.19,38.4,,172.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.05,35,,157.64,percent of total billed charges,35% of total billed charges for outpatient setting,439.14,78,,351.312,percent of total billed charges,78% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,394.1,70,,315.28,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,422.25,75,,337.8,percent of total billed charges,75% of total billed charges for outpatient setting,467.29,83,,373.832,percent of total billed charges,83% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,281.5,50,,225.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,220.51,39.17,,176.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.05,467.29,
REDUCTION DISTAL RAD,1000474,CDM,450,RC,25505,HCPCS,outpatient,,,1143,571.5,,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.91,38.4,,351.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.91,38.4,,351.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,400.05,35,,320.04,percent of total billed charges,35% of total billed charges for outpatient setting,891.54,78,,713.232,percent of total billed charges,78% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,800.1,70,,640.08,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,857.25,75,,685.8,percent of total billed charges,75% of total billed charges for outpatient setting,948.69,83,,758.952,percent of total billed charges,83% of total billed charges for outpatient setting,571.5,50,,457.2,percent of total billed charges,50% of total billed charges for outpatient setting,571.5,50,,457.2,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,447.69,39.17,,358.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,400.05,1380.55,
CAST ELBOW TO FINGER (SHORT AR,1000475,CDM,450,RC,29075,HCPCS,outpatient,,,286,143,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.1,35,,80.08,percent of total billed charges,35% of total billed charges for outpatient setting,223.08,78,,178.464,percent of total billed charges,78% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,237.38,83,,189.904,percent of total billed charges,83% of total billed charges for outpatient setting,143,50,,114.4,percent of total billed charges,50% of total billed charges for outpatient setting,143,50,,114.4,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.02,39.17,,89.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.1,237.38,
SURGIFOAM,1000476,CDM,270,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
REPAIR BLOOD VESSEL LOWER EXT,1000477,CDM,360,RC,35226,HCPCS,outpatient,,,2197,1098.5,,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,843.65,38.4,,674.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,843.65,38.4,,674.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,1647.75,75,,1318.2,percent of total billed charges,75% of total billed charges for outpatient setting,1647.75,75,,1318.2,percent of total billed charges,75% of total billed charges for outpatient setting,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,1647.75,75,,1318.2,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,768.95,35,,615.16,percent of total billed charges,35% of total billed charges for outpatient setting,1713.66,78,,1370.928,percent of total billed charges,78% of total billed charges for outpatient setting,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,1537.9,70,,1230.32,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1647.75,75,,1318.2,percent of total billed charges,75% of total billed charges for outpatient setting,1823.51,83,,1458.808,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,860.52,39.17,,688.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,1823.51,
CLOSURE OF SPLIT WOUND,1000478,CDM,360,RC,12021,HCPCS,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,659,
SUTURE REPAIR OF WOUND/LESION,1000479,CDM,450,RC,13132,HCPCS,outpatient,,,843,421.5,,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,323.71,38.4,,258.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,323.71,38.4,,258.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,632.25,75,,505.8,percent of total billed charges,75% of total billed charges for outpatient setting,632.25,75,,505.8,percent of total billed charges,75% of total billed charges for outpatient setting,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,632.25,75,,505.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.05,35,,236.04,percent of total billed charges,35% of total billed charges for outpatient setting,657.54,78,,526.032,percent of total billed charges,78% of total billed charges for outpatient setting,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,590.1,70,,472.08,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,632.25,75,,505.8,percent of total billed charges,75% of total billed charges for outpatient setting,699.69,83,,559.752,percent of total billed charges,83% of total billed charges for outpatient setting,421.5,50,,337.2,percent of total billed charges,50% of total billed charges for outpatient setting,421.5,50,,337.2,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.18,39.17,,264.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.05,699.69,
INTERMEDIATE WOUND REPAIR 2.5C,1000480,CDM,450,RC,12031,HCPCS,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,342.51,
TREAT METACARPAL FRACTURE,1000481,CDM,450,RC,26605,HCPCS,outpatient,,,725,362.5,,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,278.4,38.4,,222.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,278.4,38.4,,222.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,543.75,75,,435,percent of total billed charges,75% of total billed charges for outpatient setting,543.75,75,,435,percent of total billed charges,75% of total billed charges for outpatient setting,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,543.75,75,,435,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.75,35,,203,percent of total billed charges,35% of total billed charges for outpatient setting,565.5,78,,452.4,percent of total billed charges,78% of total billed charges for outpatient setting,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,507.5,70,,406,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,543.75,75,,435,percent of total billed charges,75% of total billed charges for outpatient setting,601.75,83,,481.4,percent of total billed charges,83% of total billed charges for outpatient setting,362.5,50,,290,percent of total billed charges,50% of total billed charges for outpatient setting,362.5,50,,290,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,283.97,39.17,,227.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,601.75,
REPAIR INTERM WOUNDS 2.6CM-7.5,1000482,CDM,450,RC,12042,HCPCS,outpatient,,,511,255.5,,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,35,,143.08,percent of total billed charges,35% of total billed charges for outpatient setting,398.58,78,,318.864,percent of total billed charges,78% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.13,83,,339.304,percent of total billed charges,83% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,200.14,39.17,,160.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,424.13,
WEDGE EXCISION OF SKIN OF NAIL,1000483,CDM,450,RC,11765,HCPCS,outpatient,,,236,118,,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.6,35,,66.08,percent of total billed charges,35% of total billed charges for outpatient setting,184.08,78,,147.264,percent of total billed charges,78% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,195.88,83,,156.704,percent of total billed charges,83% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.43,39.17,,73.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.6,342.51,
CLOSED TREATMENT DISTAL RADIAL,1000484,CDM,450,RC,25605,HCPCS,outpatient,,,1279,639.5,,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,491.14,38.4,,392.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,491.14,38.4,,392.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,959.25,75,,767.4,percent of total billed charges,75% of total billed charges for outpatient setting,959.25,75,,767.4,percent of total billed charges,75% of total billed charges for outpatient setting,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,959.25,75,,767.4,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,447.65,35,,358.12,percent of total billed charges,35% of total billed charges for outpatient setting,997.62,78,,798.096,percent of total billed charges,78% of total billed charges for outpatient setting,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,895.3,70,,716.24,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,959.25,75,,767.4,percent of total billed charges,75% of total billed charges for outpatient setting,1061.57,83,,849.256,percent of total billed charges,83% of total billed charges for outpatient setting,639.5,50,,511.6,percent of total billed charges,50% of total billed charges for outpatient setting,639.5,50,,511.6,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,500.96,39.17,,400.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,447.65,1380.55,
CLOSED TREATMENT OF JOINT DISL,1000485,CDM,450,RC,26770,HCPCS,outpatient,,,633,316.5,,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,243.07,38.4,,194.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,243.07,38.4,,194.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,474.75,75,,379.8,percent of total billed charges,75% of total billed charges for outpatient setting,474.75,75,,379.8,percent of total billed charges,75% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,474.75,75,,379.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.55,35,,177.24,percent of total billed charges,35% of total billed charges for outpatient setting,493.74,78,,394.992,percent of total billed charges,78% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,443.1,70,,354.48,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,474.75,75,,379.8,percent of total billed charges,75% of total billed charges for outpatient setting,525.39,83,,420.312,percent of total billed charges,83% of total billed charges for outpatient setting,316.5,50,,253.2,percent of total billed charges,50% of total billed charges for outpatient setting,316.5,50,,253.2,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.93,39.17,,198.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,525.39,
CLOSED TX TRIMALLEOLAR AKLE FX,1000487,CDM,450,RC,27818,HCPCS,outpatient,,,1088,544,,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,417.79,38.4,,334.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,417.79,38.4,,334.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,816,75,,652.8,percent of total billed charges,75% of total billed charges for outpatient setting,816,75,,652.8,percent of total billed charges,75% of total billed charges for outpatient setting,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,816,75,,652.8,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.8,35,,304.64,percent of total billed charges,35% of total billed charges for outpatient setting,848.64,78,,678.912,percent of total billed charges,78% of total billed charges for outpatient setting,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,761.6,70,,609.28,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,816,75,,652.8,percent of total billed charges,75% of total billed charges for outpatient setting,903.04,83,,722.432,percent of total billed charges,83% of total billed charges for outpatient setting,544,50,,435.2,percent of total billed charges,50% of total billed charges for outpatient setting,544,50,,435.2,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,426.15,39.17,,340.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.8,1380.55,
ULTRASOUND CHEST,1001003,CDM,402,RC,76604,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND ABDOMINAL COMPLETE,1001004,CDM,402,RC,76700,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND ABDOMINAL LIMITED,1001005,CDM,402,RC,76705,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND ABD BACK WALL COMP,1001006,CDM,402,RC,76770,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND ABD BACK WALL LIMIT,1001007,CDM,402,RC,76775,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,620.8,
ULTRASOUND KIDNEY TRANSPLANT/D,1001008,CDM,402,RC,76776,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND UTERUS,1001009,CDM,402,RC,76831,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,620.8,
ULTRASOUND PELVIC COMPLETE,1001010,CDM,402,RC,76856,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,620.8,
ULTRASOUND PELVIC LIMITED,1001011,CDM,402,RC,76857,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,620.8,
ULTRASOUND SCROTUM,1001012,CDM,402,RC,76870,HCPCS,outpatient,,,388,194,,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.99,38.4,,119.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.8,35,,108.64,percent of total billed charges,35% of total billed charges for outpatient setting,302.64,78,,242.112,percent of total billed charges,78% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,271.6,70,,217.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291,75,,232.8,percent of total billed charges,75% of total billed charges for outpatient setting,322.04,83,,257.632,percent of total billed charges,83% of total billed charges for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,620.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.97,39.17,,121.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.11,620.8,
IA/INTRA ARTERIAL INJECTION,1001020,CDM,450,RC,96373,HCPCS,outpatient,,,626.79,313.4,,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,240.69,38.4,,192.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,240.69,38.4,,192.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,470.09,75,,376.072,percent of total billed charges,75% of total billed charges for outpatient setting,470.09,75,,376.072,percent of total billed charges,75% of total billed charges for outpatient setting,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,470.09,75,,376.072,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,219.38,35,,175.504,percent of total billed charges,35% of total billed charges for outpatient setting,488.9,78,,391.12,percent of total billed charges,78% of total billed charges for outpatient setting,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,438.75,70,,351,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,470.09,75,,376.072,percent of total billed charges,75% of total billed charges for outpatient setting,520.24,83,,416.192,percent of total billed charges,83% of total billed charges for outpatient setting,313.4,50,,250.72,percent of total billed charges,50% of total billed charges for outpatient setting,313.4,50,,250.72,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.5,39.17,,196.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,520.24,
E.R.EM LEVEL 1 WITH 25 MODIFIER,1001021,CDM,450,RC,9928125,HCPCS,outpatient,,,222.24,111.12,,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.34,38.4,,68.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.34,38.4,,68.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,166.68,75,,133.344,percent of total billed charges,75% of total billed charges for outpatient setting,166.68,75,,133.344,percent of total billed charges,75% of total billed charges for outpatient setting,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,166.68,75,,133.344,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.78,35,,62.224,percent of total billed charges,35% of total billed charges for outpatient setting,173.35,78,,138.68,percent of total billed charges,78% of total billed charges for outpatient setting,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,155.57,70,,124.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.68,75,,133.344,percent of total billed charges,75% of total billed charges for outpatient setting,184.46,83,,147.568,percent of total billed charges,83% of total billed charges for outpatient setting,111.12,50,,88.896,percent of total billed charges,50% of total billed charges for outpatient setting,111.12,50,,88.896,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.05,39.17,,69.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,77.78,184.46,
E.R.EM LEVEL-2 WITH 25 MODIFIER,1001022,CDM,450,RC,9928225,HCPCS,outpatient,,,339.67,169.84,,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.43,38.4,,104.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.43,38.4,,104.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,254.75,75,,203.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.75,75,,203.8,percent of total billed charges,75% of total billed charges for outpatient setting,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,254.75,75,,203.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,118.88,35,,95.104,percent of total billed charges,35% of total billed charges for outpatient setting,264.94,78,,211.952,percent of total billed charges,78% of total billed charges for outpatient setting,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,237.77,70,,190.216,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,254.75,75,,203.8,percent of total billed charges,75% of total billed charges for outpatient setting,281.93,83,,225.544,percent of total billed charges,83% of total billed charges for outpatient setting,169.84,50,,135.872,percent of total billed charges,50% of total billed charges for outpatient setting,169.84,50,,135.872,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.04,39.17,,106.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,118.88,281.93,
E.R.EM LEVEL-3 WITH 25 MODIFIER,1001023,CDM,450,RC,9928325,HCPCS,outpatient,,,992.67,496.34,,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.19,38.4,,304.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,381.19,38.4,,304.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,744.5,75,,595.6,percent of total billed charges,75% of total billed charges for outpatient setting,744.5,75,,595.6,percent of total billed charges,75% of total billed charges for outpatient setting,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,744.5,75,,595.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,347.43,35,,277.944,percent of total billed charges,35% of total billed charges for outpatient setting,774.28,78,,619.424,percent of total billed charges,78% of total billed charges for outpatient setting,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,694.87,70,,555.896,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,744.5,75,,595.6,percent of total billed charges,75% of total billed charges for outpatient setting,823.92,83,,659.136,percent of total billed charges,83% of total billed charges for outpatient setting,496.34,50,,397.072,percent of total billed charges,50% of total billed charges for outpatient setting,496.34,50,,397.072,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,388.81,39.17,,311.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,347.43,823.92,
E.R.EM LEVEL 4 WITH 25 MODIFIER,1001024,CDM,450,RC,9928425,HCPCS,outpatient,,,940.69,470.35,,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,361.22,38.4,,288.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,361.22,38.4,,288.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,705.52,75,,564.416,percent of total billed charges,75% of total billed charges for outpatient setting,705.52,75,,564.416,percent of total billed charges,75% of total billed charges for outpatient setting,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,705.52,75,,564.416,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,329.24,35,,263.392,percent of total billed charges,35% of total billed charges for outpatient setting,733.74,78,,586.992,percent of total billed charges,78% of total billed charges for outpatient setting,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,658.48,70,,526.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,705.52,75,,564.416,percent of total billed charges,75% of total billed charges for outpatient setting,780.77,83,,624.616,percent of total billed charges,83% of total billed charges for outpatient setting,470.35,50,,376.28,percent of total billed charges,50% of total billed charges for outpatient setting,470.35,50,,376.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.44,39.17,,294.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,329.24,780.77,
E.R.EM LEVEL 5 WITH 25 MODIFIER,1001025,CDM,450,RC,9928525,HCPCS,outpatient,,,1350.24,675.12,,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,518.49,38.4,,414.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,518.49,38.4,,414.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,1012.68,75,,810.144,percent of total billed charges,75% of total billed charges for outpatient setting,1012.68,75,,810.144,percent of total billed charges,75% of total billed charges for outpatient setting,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,1012.68,75,,810.144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,472.58,35,,378.064,percent of total billed charges,35% of total billed charges for outpatient setting,1053.19,78,,842.552,percent of total billed charges,78% of total billed charges for outpatient setting,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,945.17,70,,756.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1012.68,75,,810.144,percent of total billed charges,75% of total billed charges for outpatient setting,1120.7,83,,896.56,percent of total billed charges,83% of total billed charges for outpatient setting,675.12,50,,540.096,percent of total billed charges,50% of total billed charges for outpatient setting,675.12,50,,540.096,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.86,39.17,,423.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,472.58,1120.7,
REMOVAL FOREIGN BODY SUBCUT COMPLEX,1001026,CDM,450,RC,10121,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
DEBRIDEMENT MUSCLE/FASCIA < 20 CM,1001027,CDM,450,RC,11043,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
DEBRIDEMENT BONE < 20 CM,1001028,CDM,450,RC,11044,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
DEBRIDEMENT OF NAIL,1001032,CDM,450,RC,11720,HCPCS,outpatient,,,170.55,85.28,,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.69,35,,47.752,percent of total billed charges,35% of total billed charges for outpatient setting,133.03,78,,106.424,percent of total billed charges,78% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,141.56,83,,113.248,percent of total billed charges,83% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.8,39.17,,53.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,141.56,
REPAIR OF NAIL BED,1001034,CDM,450,RC,11760,HCPCS,outpatient,,,1604.61,802.31,,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.17,38.4,,492.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.17,38.4,,492.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,1203.46,75,,962.768,percent of total billed charges,75% of total billed charges for outpatient setting,1203.46,75,,962.768,percent of total billed charges,75% of total billed charges for outpatient setting,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,1203.46,75,,962.768,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.61,35,,449.288,percent of total billed charges,35% of total billed charges for outpatient setting,1251.6,78,,1001.28,percent of total billed charges,78% of total billed charges for outpatient setting,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,1123.23,70,,898.584,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.46,75,,962.768,percent of total billed charges,75% of total billed charges for outpatient setting,1331.83,83,,1065.464,percent of total billed charges,83% of total billed charges for outpatient setting,802.31,50,,641.848,percent of total billed charges,50% of total billed charges for outpatient setting,802.31,50,,641.848,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.49,39.17,,502.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.83,
REPAIR INTERM WOUNDS,1001035,CDM,450,RC,12018,HCPCS,outpatient,,,550.2,275.1,,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,211.28,38.4,,169.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.28,38.4,,169.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.57,35,,154.056,percent of total billed charges,35% of total billed charges for outpatient setting,429.16,78,,343.328,percent of total billed charges,78% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,456.67,83,,365.336,percent of total billed charges,83% of total billed charges for outpatient setting,275.1,50,,220.08,percent of total billed charges,50% of total billed charges for outpatient setting,275.1,50,,220.08,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.51,39.17,,172.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,456.67,
REPAIR INTERM WOUNDS,1001036,CDM,450,RC,12034,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001037,CDM,450,RC,12035,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001038,CDM,450,RC,12036,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001039,CDM,450,RC,12037,HCPCS,outpatient,,,5247.78,2623.89,,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2015.15,38.4,,1612.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2015.15,38.4,,1612.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1836.72,35,,1469.376,percent of total billed charges,35% of total billed charges for outpatient setting,4093.27,78,,3274.616,percent of total billed charges,78% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,4355.66,83,,3484.528,percent of total billed charges,83% of total billed charges for outpatient setting,2623.89,50,,2099.112,percent of total billed charges,50% of total billed charges for outpatient setting,2623.89,50,,2099.112,percent of total billed charges,50% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2055.45,39.17,,1644.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,4355.66,
REPAIR INTERM WOUNDS,1001040,CDM,450,RC,12041,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001041,CDM,450,RC,12044,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001042,CDM,450,RC,12045,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001043,CDM,450,RC,12046,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001044,CDM,450,RC,12051,HCPCS,outpatient,,,5247.78,2623.89,,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2015.15,38.4,,1612.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2015.15,38.4,,1612.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1836.72,35,,1469.376,percent of total billed charges,35% of total billed charges for outpatient setting,4093.27,78,,3274.616,percent of total billed charges,78% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,3673.45,70,,2938.76,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3935.84,75,,3148.672,percent of total billed charges,75% of total billed charges for outpatient setting,4355.66,83,,3484.528,percent of total billed charges,83% of total billed charges for outpatient setting,2623.89,50,,2099.112,percent of total billed charges,50% of total billed charges for outpatient setting,2623.89,50,,2099.112,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2055.45,39.17,,1644.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,4355.66,
REPAIR INTERM WOUNDS,1001045,CDM,450,RC,12051,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001046,CDM,450,RC,12052,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001047,CDM,450,RC,12053,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001048,CDM,450,RC,12054,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001049,CDM,450,RC,12055,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001050,CDM,450,RC,12056,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001051,CDM,450,RC,12057,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001052,CDM,450,RC,13100,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001053,CDM,450,RC,13101,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001055,CDM,450,RC,13120,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001056,CDM,450,RC,13131,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,529.5,50,,423.6,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,878.97,
REPAIR INTERM WOUNDS,1001058,CDM,450,RC,13151,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
REPAIR INTERM WOUNDS,1001059,CDM,450,RC,13152,HCPCS,outpatient,,,1604.67,802.34,,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.19,38.4,,492.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.63,35,,449.304,percent of total billed charges,35% of total billed charges for outpatient setting,1251.64,78,,1001.312,percent of total billed charges,78% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,1123.27,70,,898.616,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.5,75,,962.8,percent of total billed charges,75% of total billed charges for outpatient setting,1331.88,83,,1065.504,percent of total billed charges,83% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,802.34,50,,641.872,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.51,39.17,,502.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,1331.88,
STERILE INJ W/O US: SACROILIAC JOINT,1001061,CDM,450,RC,20551,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
TRIGGER POINT INJECTION,1001062,CDM,360,RC,20552,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
ASPIRATION/INJECTION W/O US - FINGER,1001063,CDM,760,RC,20600,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
"ASPIRATION/INJECTION w/US FINGERS,TOES",1001064,CDM,450,RC,20604,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
ASPIRATION/INJECTION wUS,1001065,CDM,450,RC,20606,HCPCS,outpatient,,,1945.56,972.78,,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,747.1,38.4,,597.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,747.1,38.4,,597.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,1459.17,75,,1167.336,percent of total billed charges,75% of total billed charges for outpatient setting,1459.17,75,,1167.336,percent of total billed charges,75% of total billed charges for outpatient setting,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,1459.17,75,,1167.336,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,680.95,35,,544.76,percent of total billed charges,35% of total billed charges for outpatient setting,1517.54,78,,1214.032,percent of total billed charges,78% of total billed charges for outpatient setting,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,1361.89,70,,1089.512,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1459.17,75,,1167.336,percent of total billed charges,75% of total billed charges for outpatient setting,1614.81,83,,1291.848,percent of total billed charges,83% of total billed charges for outpatient setting,972.78,50,,778.224,percent of total billed charges,50% of total billed charges for outpatient setting,972.78,50,,778.224,percent of total billed charges,50% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.04,39.17,,609.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,1614.81,
ASPIRATION/INJECTION wUS,1001066,CDM,450,RC,20611,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
SOFT TISSUE FB REMOVAL -SHOULDER,1001067,CDM,450,RC,23330,HCPCS,outpatient,,,1906.62,953.31,,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,732.14,38.4,,585.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,732.14,38.4,,585.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1429.97,75,,1143.976,percent of total billed charges,75% of total billed charges for outpatient setting,1429.97,75,,1143.976,percent of total billed charges,75% of total billed charges for outpatient setting,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1429.97,75,,1143.976,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,667.32,35,,533.856,percent of total billed charges,35% of total billed charges for outpatient setting,1487.16,78,,1189.728,percent of total billed charges,78% of total billed charges for outpatient setting,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1334.63,70,,1067.704,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1429.97,75,,1143.976,percent of total billed charges,75% of total billed charges for outpatient setting,1582.49,83,,1265.992,percent of total billed charges,83% of total billed charges for outpatient setting,953.31,50,,762.648,percent of total billed charges,50% of total billed charges for outpatient setting,953.31,50,,762.648,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,746.78,39.17,,597.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,667.32,1582.49,
SOFT TISSUE FB REMOVAL -SHOULDER-DEEP,1001068,CDM,450,RC,23333,HCPCS,outpatient,,,7264.65,3632.33,,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2542.63,35,,2034.104,percent of total billed charges,35% of total billed charges for outpatient setting,5666.43,78,,4533.144,percent of total billed charges,78% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,6029.66,83,,4823.728,percent of total billed charges,83% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2845.42,39.17,,2276.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,6029.66,
CLOSED FRACTURE REDUCTION CLAVICULAR,1001069,CDM,450,RC,23505,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION PROXIMALHUMERA,1001070,CDM,450,RC,23605,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
SOFT TISSUE FB REMOVAL -UPPER ARM,1001071,CDM,450,RC,24200,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
SOFT TISSUE FB REMOVAL -UPPER ARM-DEEP,1001072,CDM,450,RC,24201,HCPCS,outpatient,,,7264.65,3632.33,,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2542.63,35,,2034.104,percent of total billed charges,35% of total billed charges for outpatient setting,5666.43,78,,4533.144,percent of total billed charges,78% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,6029.66,83,,4823.728,percent of total billed charges,83% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2845.42,39.17,,2276.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,6029.66,
CLOSED TREATMENT HUMERAL SHAFT,1001073,CDM,450,RC,24505,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001074,CDM,450,RC,24530,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION SUPRACONDYLAR,1001075,CDM,450,RC,24535,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
REDUCTION NURSEMAID'S ELBOW DISLOCATION,1001076,CDM,450,RC,24640,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION RADIAL HEAD,1001077,CDM,450,RC,24655,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001078,CDM,450,RC,24670,HCPCS,outpatient,,,631.68,315.84,,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.57,38.4,,194.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.57,38.4,,194.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,473.76,75,,379.008,percent of total billed charges,75% of total billed charges for outpatient setting,473.76,75,,379.008,percent of total billed charges,75% of total billed charges for outpatient setting,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,473.76,75,,379.008,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.09,35,,176.872,percent of total billed charges,35% of total billed charges for outpatient setting,492.71,78,,394.168,percent of total billed charges,78% of total billed charges for outpatient setting,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,442.18,70,,353.744,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.76,75,,379.008,percent of total billed charges,75% of total billed charges for outpatient setting,524.29,83,,419.432,percent of total billed charges,83% of total billed charges for outpatient setting,315.84,50,,252.672,percent of total billed charges,50% of total billed charges for outpatient setting,315.84,50,,252.672,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.42,39.17,,197.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.29,
CLOSED FRACTURE REDUCTION ULNAR,1001079,CDM,450,RC,24675,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
100CLOSED FRACTURE REDUCTION ULNAR SHAFT,1001080,CDM,450,RC,25535,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION RADIAL/ULNAR S,1001081,CDM,450,RC,25565,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
INCISION & DRAINAGE - FINGER,1001082,CDM,450,RC,26010,HCPCS,outpatient,,,550.2,275.1,,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,211.28,38.4,,169.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.28,38.4,,169.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.57,35,,154.056,percent of total billed charges,35% of total billed charges for outpatient setting,429.16,78,,343.328,percent of total billed charges,78% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,385.14,70,,308.112,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,412.65,75,,330.12,percent of total billed charges,75% of total billed charges for outpatient setting,456.67,83,,365.336,percent of total billed charges,83% of total billed charges for outpatient setting,275.1,50,,220.08,percent of total billed charges,50% of total billed charges for outpatient setting,275.1,50,,220.08,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.51,39.17,,172.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,456.67,
REPAIR INTERM WOUNDS,1001083,CDM,450,RC,26410,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
REPAIR INTERM WOUNDS,1001084,CDM,450,RC,26418,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED FINGER REDUCTION,1001085,CDM,450,RC,26700,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
DISLOCATED FINGER REDUCTION/SEDATION,1001086,CDM,450,RC,26705,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED TREATMENT DISTAL PHALANGEAL,1001087,CDM,450,RC,26755,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
SOFT TISSUE FB REMOVAL - PELVIS/HIP,1001088,CDM,450,RC,27086,HCPCS,outpatient,,,7264.65,3632.33,,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2789.63,38.4,,2231.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2542.63,35,,2034.104,percent of total billed charges,35% of total billed charges for outpatient setting,5666.43,78,,4533.144,percent of total billed charges,78% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,5085.26,70,,4068.208,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5448.49,75,,4358.792,percent of total billed charges,75% of total billed charges for outpatient setting,6029.66,83,,4823.728,percent of total billed charges,83% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,3632.33,50,,2905.864,percent of total billed charges,50% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2845.42,39.17,,2276.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,6029.66,
SOFT TISSUE FB REMOVAL - PELVIS/HIP DEEP,1001089,CDM,450,RC,27087,HCPCS,outpatient,,,8676.84,4338.42,,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3331.91,38.4,,2665.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3331.91,38.4,,2665.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,6507.63,75,,5206.104,percent of total billed charges,75% of total billed charges for outpatient setting,6507.63,75,,5206.104,percent of total billed charges,75% of total billed charges for outpatient setting,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,6507.63,75,,5206.104,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3036.89,35,,2429.512,percent of total billed charges,35% of total billed charges for outpatient setting,6767.94,78,,5414.352,percent of total billed charges,78% of total billed charges for outpatient setting,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,6073.79,70,,4859.032,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6507.63,75,,5206.104,percent of total billed charges,75% of total billed charges for outpatient setting,7201.78,83,,5761.424,percent of total billed charges,83% of total billed charges for outpatient setting,4338.42,50,,3470.736,percent of total billed charges,50% of total billed charges for outpatient setting,4338.42,50,,3470.736,percent of total billed charges,50% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3398.55,39.17,,2718.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,7201.78,
DISLOCATED TRAUMATIC HIP REDUCTION,1001091,CDM,450,RC,27250,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
DISLOCATED TRAUMATIC HIP REDUCTION,1001092,CDM,450,RC,27252,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED SPONTANEOUS HIP REDUCTION,1001093,CDM,450,RC,27256,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
DISLOCATED SPONTANEOUS HIP REDUCTION,1001094,CDM,450,RC,27257,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED  HIP REDUCTION/POST ARTHROPLA,1001095,CDM,450,RC,27265,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
DISLOCATED  HIP REDUCTION/POST ARTHROPLA,1001096,CDM,450,RC,27266,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001097,CDM,450,RC,27824,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED TREATMENT FEMORAL SHAFT,1001098,CDM,450,RC,27502,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION SUPRACONDYLAR,1001099,CDM,450,RC,27503,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001100,CDM,450,RC,27508,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED TREATMENT FEMORAL DISTAL END,1001101,CDM,450,RC,27510,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED KNEE REDUCTION,1001102,CDM,450,RC,27550,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
KNEE DISLOCATION REDUCTION / SEDATION,1001103,CDM,450,RC,27552,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION TIBIAL SHAFT,1001104,CDM,450,RC,27752,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001105,CDM,450,RC,28490,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED TREATMENT MEDIAL MALLEOLUS,1001106,CDM,450,RC,27762,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001107,CDM,450,RC,27767,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION PPOSTERIOR MAL,1001108,CDM,450,RC,27768,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001109,CDM,450,RC,27780,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION PROXIMAL FIBUL,1001110,CDM,450,RC,27780,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001111,CDM,450,RC,27786,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED TREATMENT DISTAL FIBULAR,1001112,CDM,450,RC,27788,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001113,CDM,450,RC,27808,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED TREATMENT BIMALLEOLAR,1001114,CDM,450,RC,27810,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001115,CDM,450,RC,27816,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001116,CDM,450,RC,27824,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION WEIGHT BEARING,1001117,CDM,450,RC,27825,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED ANKLE REDUCTION,1001118,CDM,450,RC,27840,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
ANKLE DISLOCATION REDUCTION/SEDATION,1001119,CDM,760,RC,27842,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
SOFT TISSUE FB REMOVAL - FOOT - DEEP,1001120,CDM,450,RC,28192,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
SOFT TISSUE FB REMOVAL - FOOT - COMPLEX,1001121,CDM,450,RC,28193,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001122,CDM,450,RC,28470,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION METATARSAL,1001123,CDM,450,RC,28475,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION W/O MANIPULAT,1001124,CDM,450,RC,28490,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
CLOSED FRACTURE REDUCTION PHALANX,1001125,CDM,450,RC,28515,HCPCS,outpatient,,,631.5,315.75,,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.5,38.4,,194,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.03,35,,176.824,percent of total billed charges,35% of total billed charges for outpatient setting,492.57,78,,394.056,percent of total billed charges,78% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,442.05,70,,353.64,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.63,75,,378.904,percent of total billed charges,75% of total billed charges for outpatient setting,524.15,83,,419.32,percent of total billed charges,83% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,315.75,50,,252.6,percent of total billed charges,50% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.35,39.17,,197.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,524.15,
DISLOCATED TOE  REDUCTION/METATARSOPHALA,1001126,CDM,450,RC,28635,HCPCS,outpatient,,,4267.53,2133.77,,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1638.73,38.4,,1310.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1493.64,35,,1194.912,percent of total billed charges,35% of total billed charges for outpatient setting,3328.67,78,,2662.936,percent of total billed charges,78% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,2987.27,70,,2389.816,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3200.65,75,,2560.52,percent of total billed charges,75% of total billed charges for outpatient setting,3542.05,83,,2833.64,percent of total billed charges,83% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,2133.77,50,,1707.016,percent of total billed charges,50% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671.5,39.17,,1337.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,3542.05,
DISLOCATED TOE REDUCTIOM INTERPHALANGEAL,1001127,CDM,450,RC,28665,HCPCS,outpatient,,,739.14,369.57,,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.7,35,,206.96,percent of total billed charges,35% of total billed charges for outpatient setting,576.53,78,,461.224,percent of total billed charges,78% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,613.49,83,,490.792,percent of total billed charges,83% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.51,39.17,,231.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,613.49,
CAST -  LONG ARM,1001128,CDM,450,RC,29065,HCPCS,outpatient,,,739.14,369.57,,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.7,35,,206.96,percent of total billed charges,35% of total billed charges for outpatient setting,576.53,78,,461.224,percent of total billed charges,78% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,613.49,83,,490.792,percent of total billed charges,83% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.51,39.17,,231.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,613.49,
APPLY STRAP THORAX,1001129,CDM,450,RC,29200,HCPCS,outpatient,,,432.87,216.44,,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,166.22,38.4,,132.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.22,38.4,,132.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.5,35,,121.2,percent of total billed charges,35% of total billed charges for outpatient setting,337.64,78,,270.112,percent of total billed charges,78% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,359.28,83,,287.424,percent of total billed charges,83% of total billed charges for outpatient setting,216.44,50,,173.152,percent of total billed charges,50% of total billed charges for outpatient setting,216.44,50,,173.152,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.54,39.17,,135.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,359.28,
CAST LONG LEG,1001130,CDM,450,RC,29345,HCPCS,outpatient,,,739.14,369.57,,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.7,35,,206.96,percent of total billed charges,35% of total billed charges for outpatient setting,576.53,78,,461.224,percent of total billed charges,78% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,613.49,83,,490.792,percent of total billed charges,83% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.51,39.17,,231.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,613.49,
CAST SHORT LEG,1001131,CDM,450,RC,29405,HCPCS,outpatient,,,739.14,369.57,,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.83,38.4,,227.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.7,35,,206.96,percent of total billed charges,35% of total billed charges for outpatient setting,576.53,78,,461.224,percent of total billed charges,78% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,517.4,70,,413.92,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.36,75,,443.488,percent of total billed charges,75% of total billed charges for outpatient setting,613.49,83,,490.792,percent of total billed charges,83% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,369.57,50,,295.656,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.51,39.17,,231.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,613.49,
APPLY STRAP UNNA BOOT,1001132,CDM,450,RC,29580,HCPCS,outpatient,,,432.87,216.44,,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,166.22,38.4,,132.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.22,38.4,,132.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.5,35,,121.2,percent of total billed charges,35% of total billed charges for outpatient setting,337.64,78,,270.112,percent of total billed charges,78% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,303.01,70,,242.408,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.65,75,,259.72,percent of total billed charges,75% of total billed charges for outpatient setting,359.28,83,,287.424,percent of total billed charges,83% of total billed charges for outpatient setting,216.44,50,,173.152,percent of total billed charges,50% of total billed charges for outpatient setting,216.44,50,,173.152,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.54,39.17,,135.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,359.28,
CRICOTHYROTOMY,1001133,CDM,450,RC,31605,HCPCS,outpatient,,,648.21,324.11,,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.87,35,,181.496,percent of total billed charges,35% of total billed charges for outpatient setting,505.6,78,,404.48,percent of total billed charges,78% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,538.01,83,,430.408,percent of total billed charges,83% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.89,39.17,,203.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,538.01,
THORACENTESIS,1001137,CDM,450,RC,32554,HCPCS,outpatient,,,1656.12,828.06,,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,539.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,635.95,38.4,,508.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,635.95,38.4,,508.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,579.64,35,,463.712,percent of total billed charges,35% of total billed charges for outpatient setting,1291.77,78,,1033.416,percent of total billed charges,78% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1374.58,83,,1099.664,percent of total billed charges,83% of total billed charges for outpatient setting,828.06,50,,662.448,percent of total billed charges,50% of total billed charges for outpatient setting,828.06,50,,662.448,percent of total billed charges,50% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,648.67,39.17,,518.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,1374.58,
THORACENTESIS W/IMAGING GUIDANCE,1001138,CDM,450,RC,32555,HCPCS,outpatient,,,1656.12,828.06,,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,539.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,635.95,38.4,,508.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,635.95,38.4,,508.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,579.64,35,,463.712,percent of total billed charges,35% of total billed charges for outpatient setting,1291.77,78,,1033.416,percent of total billed charges,78% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,1159.28,70,,927.424,percent of total billed charges,70% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1242.09,75,,993.672,percent of total billed charges,75% of total billed charges for outpatient setting,1374.58,83,,1099.664,percent of total billed charges,83% of total billed charges for outpatient setting,828.06,50,,662.448,percent of total billed charges,50% of total billed charges for outpatient setting,828.06,50,,662.448,percent of total billed charges,50% of total billed charges for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,648.67,39.17,,518.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.6,1374.58,
PERICARDIOCENTESIS,1001139,CDM,450,RC,33016,HCPCS,outpatient,,,4308.48,2154.24,,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1654.46,38.4,,1323.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1654.46,38.4,,1323.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,3231.36,75,,2585.088,percent of total billed charges,75% of total billed charges for outpatient setting,3231.36,75,,2585.088,percent of total billed charges,75% of total billed charges for outpatient setting,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,3231.36,75,,2585.088,percent of total billed charges,75% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1507.97,35,,1206.376,percent of total billed charges,35% of total billed charges for outpatient setting,3360.61,78,,2688.488,percent of total billed charges,78% of total billed charges for outpatient setting,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,3015.94,70,,2412.752,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3231.36,75,,2585.088,percent of total billed charges,75% of total billed charges for outpatient setting,3576.04,83,,2860.832,percent of total billed charges,83% of total billed charges for outpatient setting,2154.24,50,,1723.392,percent of total billed charges,50% of total billed charges for outpatient setting,2154.24,50,,1723.392,percent of total billed charges,50% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1687.55,39.17,,1350.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,3576.04,
VENIPUNCTURE CUTDOWN < 1 YEAR,1001143,CDM,450,RC,36420,HCPCS,outpatient,,,345.48,172.74,,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.92,35,,96.736,percent of total billed charges,35% of total billed charges for outpatient setting,269.47,78,,215.576,percent of total billed charges,78% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,286.75,83,,229.4,percent of total billed charges,83% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.31,39.17,,108.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,286.75,
VENIPUNCTURE CUTDOWN > 1 YEAR,1001144,CDM,450,RC,36425,HCPCS,outpatient,,,831.54,415.77,,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,35,,232.832,percent of total billed charges,35% of total billed charges for outpatient setting,648.6,78,,518.88,percent of total billed charges,78% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,690.18,83,,552.144,percent of total billed charges,83% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.7,39.17,,260.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,690.18,
CENTRAL LINE < 5 years,1001145,CDM,450,RC,36555,HCPCS,outpatient,,,8770.89,4385.45,,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3368.02,38.4,,2694.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3368.02,38.4,,2694.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,6578.17,75,,5262.536,percent of total billed charges,75% of total billed charges for outpatient setting,6578.17,75,,5262.536,percent of total billed charges,75% of total billed charges for outpatient setting,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,6578.17,75,,5262.536,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3069.81,35,,2455.848,percent of total billed charges,35% of total billed charges for outpatient setting,6841.29,78,,5473.032,percent of total billed charges,78% of total billed charges for outpatient setting,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,6139.62,70,,4911.696,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6578.17,75,,5262.536,percent of total billed charges,75% of total billed charges for outpatient setting,7279.84,83,,5823.872,percent of total billed charges,83% of total billed charges for outpatient setting,4385.45,50,,3508.36,percent of total billed charges,50% of total billed charges for outpatient setting,4385.45,50,,3508.36,percent of total billed charges,50% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3435.38,39.17,,2748.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,7279.84,
CEREBRAL THROMBOSIS - THERAPY FOR STROKE,1001147,CDM,450,RC,37195,HCPCS,outpatient,,,976.92,488.46,,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,375.14,38.4,,300.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,375.14,38.4,,300.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,341.92,35,,273.536,percent of total billed charges,35% of total billed charges for outpatient setting,762,78,,609.6,percent of total billed charges,78% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,810.84,83,,648.672,percent of total billed charges,83% of total billed charges for outpatient setting,488.46,50,,390.768,percent of total billed charges,50% of total billed charges for outpatient setting,488.46,50,,390.768,percent of total billed charges,50% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,382.64,39.17,,306.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,810.84,
REBOA (RESUCITATIVE ENDOVASCULAR AORTA),1001148,CDM,450,RC,37244,HCPCS,outpatient,,,30775.47,15387.74,,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,9449.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11817.78,38.4,,9454.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11817.78,38.4,,9454.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,23081.6,75,,18465.28,percent of total billed charges,75% of total billed charges for outpatient setting,23081.6,75,,18465.28,percent of total billed charges,75% of total billed charges for outpatient setting,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,23081.6,75,,18465.28,percent of total billed charges,75% of total billed charges for outpatient setting,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10771.41,35,,8617.128,percent of total billed charges,35% of total billed charges for outpatient setting,24004.87,78,,19203.896,percent of total billed charges,78% of total billed charges for outpatient setting,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,21542.83,70,,17234.264,percent of total billed charges,70% of total billed charges for outpatient setting,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23081.6,75,,18465.28,percent of total billed charges,75% of total billed charges for outpatient setting,25543.64,83,,20434.912,percent of total billed charges,83% of total billed charges for outpatient setting,15387.74,50,,12310.192,percent of total billed charges,50% of total billed charges for outpatient setting,15387.74,50,,12310.192,percent of total billed charges,50% of total billed charges for outpatient setting,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12054.14,39.17,,9643.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,9449.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9449.77,25543.64,
SOFT TISSUE FB REMOVAL-VESTIBULE MOUTH,1001149,CDM,450,RC,40804,HCPCS,outpatient,,,2479.17,1239.59,,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,867.71,35,,694.168,percent of total billed charges,35% of total billed charges for outpatient setting,1933.75,78,,1547,percent of total billed charges,78% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,2057.71,83,,1646.168,percent of total billed charges,83% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.04,39.17,,776.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,2057.71,
SOFT TISSUE FB REMOVAL-VESTIBULE COMPLEX,1001150,CDM,450,RC,40805,HCPCS,outpatient,,,1385.7,692.85,,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,472.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,532.11,38.4,,425.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,532.11,38.4,,425.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,1039.28,75,,831.424,percent of total billed charges,75% of total billed charges for outpatient setting,1039.28,75,,831.424,percent of total billed charges,75% of total billed charges for outpatient setting,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,1039.28,75,,831.424,percent of total billed charges,75% of total billed charges for outpatient setting,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,485,35,,388,percent of total billed charges,35% of total billed charges for outpatient setting,1080.85,78,,864.68,percent of total billed charges,78% of total billed charges for outpatient setting,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,969.99,70,,775.992,percent of total billed charges,70% of total billed charges for outpatient setting,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1039.28,75,,831.424,percent of total billed charges,75% of total billed charges for outpatient setting,1150.13,83,,920.104,percent of total billed charges,83% of total billed charges for outpatient setting,692.85,50,,554.28,percent of total billed charges,50% of total billed charges for outpatient setting,692.85,50,,554.28,percent of total billed charges,50% of total billed charges for outpatient setting,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,542.75,39.17,,434.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,472.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,472.61,1150.13,
REPAIR INTERM WOUNDS - MOUTH/ <2.5CM,1001151,CDM,450,RC,41250,HCPCS,outpatient,,,831.54,415.77,,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,35,,232.832,percent of total billed charges,35% of total billed charges for outpatient setting,648.6,78,,518.88,percent of total billed charges,78% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,690.18,83,,552.144,percent of total billed charges,83% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.7,39.17,,260.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,690.18,
REPAIR INTERM WOUNDS - MOUTH/TONGUE POST,1001152,CDM,450,RC,41251,HCPCS,outpatient,,,648.21,324.11,,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.87,35,,181.496,percent of total billed charges,35% of total billed charges for outpatient setting,505.6,78,,404.48,percent of total billed charges,78% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,538.01,83,,430.408,percent of total billed charges,83% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.89,39.17,,203.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,538.01,
REPAIR INTERM WOUNDS - MOUTH/ >2.6CM,1001153,CDM,450,RC,41252,HCPCS,outpatient,,,648.21,324.11,,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.87,35,,181.496,percent of total billed charges,35% of total billed charges for outpatient setting,505.6,78,,404.48,percent of total billed charges,78% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,538.01,83,,430.408,percent of total billed charges,83% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.89,39.17,,203.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,538.01,
INCISION & DRAINAGE -PERITONSILLAR,1001154,CDM,450,RC,42700,HCPCS,outpatient,,,648.21,324.11,,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,248.91,38.4,,199.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.87,35,,181.496,percent of total billed charges,35% of total billed charges for outpatient setting,505.6,78,,404.48,percent of total billed charges,78% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,453.75,70,,363,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,486.16,75,,388.928,percent of total billed charges,75% of total billed charges for outpatient setting,538.01,83,,430.408,percent of total billed charges,83% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,324.11,50,,259.288,percent of total billed charges,50% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.89,39.17,,203.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,538.01,
SOFT TISSUE FB REMOVAL - PHARYNX,1001155,CDM,450,RC,42809,HCPCS,outpatient,,,831.54,415.77,,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,35,,232.832,percent of total billed charges,35% of total billed charges for outpatient setting,648.6,78,,518.88,percent of total billed charges,78% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,690.18,83,,552.144,percent of total billed charges,83% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.7,39.17,,260.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,690.18,
GASTRIC INTUBATION / FLUOROSCOPIC,1001156,CDM,450,RC,43752,HCPCS,outpatient,,,831.54,415.77,,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,35,,232.832,percent of total billed charges,35% of total billed charges for outpatient setting,648.6,78,,518.88,percent of total billed charges,78% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,690.18,83,,552.144,percent of total billed charges,83% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.7,39.17,,260.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,690.18,
GASTRIC INTUBATION,1001157,CDM,450,RC,43753,HCPCS,outpatient,,,810.87,405.44,,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,311.37,38.4,,249.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,311.37,38.4,,249.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,608.15,75,,486.52,percent of total billed charges,75% of total billed charges for outpatient setting,608.15,75,,486.52,percent of total billed charges,75% of total billed charges for outpatient setting,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,608.15,75,,486.52,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,283.8,35,,227.04,percent of total billed charges,35% of total billed charges for outpatient setting,632.48,78,,505.984,percent of total billed charges,78% of total billed charges for outpatient setting,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,567.61,70,,454.088,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,608.15,75,,486.52,percent of total billed charges,75% of total billed charges for outpatient setting,673.02,83,,538.416,percent of total billed charges,83% of total billed charges for outpatient setting,405.44,50,,324.352,percent of total billed charges,50% of total billed charges for outpatient setting,405.44,50,,324.352,percent of total billed charges,50% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,317.6,39.17,,254.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,673.02,
INCISION & DRAINAGE -PERIRECTAL,1001158,CDM,450,RC,46040,HCPCS,outpatient,,,3177.18,1588.59,,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1220.04,38.4,,976.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1220.04,38.4,,976.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,2382.89,75,,1906.312,percent of total billed charges,75% of total billed charges for outpatient setting,2382.89,75,,1906.312,percent of total billed charges,75% of total billed charges for outpatient setting,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,2382.89,75,,1906.312,percent of total billed charges,75% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1112.01,35,,889.608,percent of total billed charges,35% of total billed charges for outpatient setting,2478.2,78,,1982.56,percent of total billed charges,78% of total billed charges for outpatient setting,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,2224.03,70,,1779.224,percent of total billed charges,70% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2382.89,75,,1906.312,percent of total billed charges,75% of total billed charges for outpatient setting,2637.06,83,,2109.648,percent of total billed charges,83% of total billed charges for outpatient setting,1588.59,50,,1270.872,percent of total billed charges,50% of total billed charges for outpatient setting,1588.59,50,,1270.872,percent of total billed charges,50% of total billed charges for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1244.44,39.17,,995.552,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1013.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1013.64,2637.06,
ANOSCOPY,1001159,CDM,760,RC,46600,HCPCS,outpatient,,,345.48,172.74,,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.92,35,,96.736,percent of total billed charges,35% of total billed charges for outpatient setting,269.47,78,,215.576,percent of total billed charges,78% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,286.75,83,,229.4,percent of total billed charges,83% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.31,39.17,,108.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,286.75,
ANOSCOPY - WITH REMOVAL FB,1001160,CDM,760,RC,46608,HCPCS,outpatient,,,2431.44,1215.72,,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,933.67,38.4,,746.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,933.67,38.4,,746.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,1823.58,75,,1458.864,percent of total billed charges,75% of total billed charges for outpatient setting,1823.58,75,,1458.864,percent of total billed charges,75% of total billed charges for outpatient setting,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,1823.58,75,,1458.864,percent of total billed charges,75% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,851,35,,680.8,percent of total billed charges,35% of total billed charges for outpatient setting,1896.52,78,,1517.216,percent of total billed charges,78% of total billed charges for outpatient setting,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,1702.01,70,,1361.608,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1823.58,75,,1458.864,percent of total billed charges,75% of total billed charges for outpatient setting,2018.1,83,,1614.48,percent of total billed charges,83% of total billed charges for outpatient setting,1215.72,50,,972.576,percent of total billed charges,50% of total billed charges for outpatient setting,1215.72,50,,972.576,percent of total billed charges,50% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,952.34,39.17,,761.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,2018.1,
ABDOMINAL PARACENTESIS,1001161,CDM,760,RC,49082,HCPCS,outpatient,,,2479.17,1239.59,,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,867.71,35,,694.168,percent of total billed charges,35% of total billed charges for outpatient setting,1933.75,78,,1547,percent of total billed charges,78% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,2057.71,83,,1646.168,percent of total billed charges,83% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.04,39.17,,776.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,2057.71,
ABDOMINAL PARACENTESIS W IMAGING GUIDANC,1001162,CDM,760,RC,49083,HCPCS,outpatient,,,2479.17,1239.59,,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,867.71,35,,694.168,percent of total billed charges,35% of total billed charges for outpatient setting,1933.75,78,,1547,percent of total billed charges,78% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,2057.71,83,,1646.168,percent of total billed charges,83% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.04,39.17,,776.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,2057.71,
PERITONEAL LAVAGE,1001163,CDM,450,RC,49084,HCPCS,outpatient,,,2479.17,1239.59,,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952,38.4,,761.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,867.71,35,,694.168,percent of total billed charges,35% of total billed charges for outpatient setting,1933.75,78,,1547,percent of total billed charges,78% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,1735.42,70,,1388.336,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1859.38,75,,1487.504,percent of total billed charges,75% of total billed charges for outpatient setting,2057.71,83,,1646.168,percent of total billed charges,83% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,1239.59,50,,991.672,percent of total billed charges,50% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.04,39.17,,776.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,2057.71,
BLADDER SCAN,1001164,CDM,450,RC,51798,HCPCS,outpatient,,,170.55,85.28,,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.69,35,,47.752,percent of total billed charges,35% of total billed charges for outpatient setting,133.03,78,,106.424,percent of total billed charges,78% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,141.56,83,,113.248,percent of total billed charges,83% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.8,39.17,,53.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,141.56,
INCISION & DRAINAGE -SCROTAL,1001165,CDM,450,RC,55100,HCPCS,outpatient,,,4310.97,2155.49,,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1655.41,38.4,,1324.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1508.84,35,,1207.072,percent of total billed charges,35% of total billed charges for outpatient setting,3362.56,78,,2690.048,percent of total billed charges,78% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,3017.68,70,,2414.144,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3233.23,75,,2586.584,percent of total billed charges,75% of total billed charges for outpatient setting,3578.11,83,,2862.488,percent of total billed charges,83% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,2155.49,50,,1724.392,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1688.52,39.17,,1350.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,3578.11,
VAGINAL DELIVERY,1001166,CDM,450,RC,59409,HCPCS,outpatient,,,8038.68,4019.34,,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3086.85,38.4,,2469.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3086.85,38.4,,2469.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2813.54,35,,2250.832,percent of total billed charges,35% of total billed charges for outpatient setting,6270.17,78,,5016.136,percent of total billed charges,78% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,6672.1,83,,5337.68,percent of total billed charges,83% of total billed charges for outpatient setting,4019.34,50,,3215.472,percent of total billed charges,50% of total billed charges for outpatient setting,4019.34,50,,3215.472,percent of total billed charges,50% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3148.59,39.17,,2518.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,6672.1,
DELIVERY OF PLACENTA,1001167,CDM,450,RC,59414,HCPCS,outpatient,,,8038.68,4019.34,,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3086.85,38.4,,2469.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3086.85,38.4,,2469.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2813.54,35,,2250.832,percent of total billed charges,35% of total billed charges for outpatient setting,6270.17,78,,5016.136,percent of total billed charges,78% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,5627.08,70,,4501.664,percent of total billed charges,70% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6029.01,75,,4823.208,percent of total billed charges,75% of total billed charges for outpatient setting,6672.1,83,,5337.68,percent of total billed charges,83% of total billed charges for outpatient setting,4019.34,50,,3215.472,percent of total billed charges,50% of total billed charges for outpatient setting,4019.34,50,,3215.472,percent of total billed charges,50% of total billed charges for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3148.59,39.17,,2518.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2685.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2685.48,6672.1,
NERVE BLOCK/DENTAL BLOCK,1001168,CDM,450,RC,64400,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
GREATER OCCIPITAL NERVE BLOCK,1001169,CDM,450,RC,64405,HCPCS,outpatient,,,800.49,400.25,,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.39,38.4,,245.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,280.17,35,,224.136,percent of total billed charges,35% of total billed charges for outpatient setting,624.38,78,,499.504,percent of total billed charges,78% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,560.34,70,,448.272,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.37,75,,480.296,percent of total billed charges,75% of total billed charges for outpatient setting,664.41,83,,531.528,percent of total billed charges,83% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,400.25,50,,320.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.54,39.17,,250.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,664.41,
STERILE INJ W/O US: FACET THORACIC CERV,1001170,CDM,450,RC,64490,HCPCS,outpatient,,,2522.19,1261.1,,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,968.52,38.4,,774.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,968.52,38.4,,774.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,1891.64,75,,1513.312,percent of total billed charges,75% of total billed charges for outpatient setting,1891.64,75,,1513.312,percent of total billed charges,75% of total billed charges for outpatient setting,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,1891.64,75,,1513.312,percent of total billed charges,75% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,882.77,35,,706.216,percent of total billed charges,35% of total billed charges for outpatient setting,1967.31,78,,1573.848,percent of total billed charges,78% of total billed charges for outpatient setting,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,1765.53,70,,1412.424,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1891.64,75,,1513.312,percent of total billed charges,75% of total billed charges for outpatient setting,2093.42,83,,1674.736,percent of total billed charges,83% of total billed charges for outpatient setting,1261.1,50,,1008.88,percent of total billed charges,50% of total billed charges for outpatient setting,1261.1,50,,1008.88,percent of total billed charges,50% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.89,39.17,,790.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,2093.42,
NERVE BLOCK/STERILE NEEDLE INJECTION U/S,1001171,CDM,450,RC,64493,HCPCS,outpatient,,,2252.19,1126.1,,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,864.84,38.4,,691.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,864.84,38.4,,691.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,1689.14,75,,1351.312,percent of total billed charges,75% of total billed charges for outpatient setting,1689.14,75,,1351.312,percent of total billed charges,75% of total billed charges for outpatient setting,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,1689.14,75,,1351.312,percent of total billed charges,75% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,788.27,35,,630.616,percent of total billed charges,35% of total billed charges for outpatient setting,1756.71,78,,1405.368,percent of total billed charges,78% of total billed charges for outpatient setting,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,1576.53,70,,1261.224,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1689.14,75,,1351.312,percent of total billed charges,75% of total billed charges for outpatient setting,1869.32,83,,1495.456,percent of total billed charges,83% of total billed charges for outpatient setting,1126.1,50,,900.88,percent of total billed charges,50% of total billed charges for outpatient setting,1126.1,50,,900.88,percent of total billed charges,50% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,882.14,39.17,,705.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,1869.32,
REMOVAL FOREIGN BODY EYE CONJUNCTIVAL,1001172,CDM,450,RC,65435,HCPCS,outpatient,,,831.54,415.77,,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,869.66,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.31,38.4,,255.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,35,,232.832,percent of total billed charges,35% of total billed charges for outpatient setting,648.6,78,,518.88,percent of total billed charges,78% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,582.08,70,,465.664,percent of total billed charges,70% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,623.66,75,,498.928,percent of total billed charges,75% of total billed charges for outpatient setting,690.18,83,,552.144,percent of total billed charges,83% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,415.77,50,,332.616,percent of total billed charges,50% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.7,39.17,,260.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.04,869.66,
REMOVAL FOREIGN BODY CORNEAL S,1001173,CDM,450,RC,65220,HCPCS,outpatient,,,345.48,172.74,,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.66,38.4,,106.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.92,35,,96.736,percent of total billed charges,35% of total billed charges for outpatient setting,269.47,78,,215.576,percent of total billed charges,78% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,241.84,70,,193.472,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,259.11,75,,207.288,percent of total billed charges,75% of total billed charges for outpatient setting,286.75,83,,229.4,percent of total billed charges,83% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,172.74,50,,138.192,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.31,39.17,,108.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.92,342.25,
REMOVAL FOREIGN BODY EYE EPITHELIUM,1001174,CDM,450,RC,65435,HCPCS,outpatient,,,2481.18,1240.59,,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,869.66,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,952.77,38.4,,762.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,952.77,38.4,,762.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,1860.89,75,,1488.712,percent of total billed charges,75% of total billed charges for outpatient setting,1860.89,75,,1488.712,percent of total billed charges,75% of total billed charges for outpatient setting,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,1860.89,75,,1488.712,percent of total billed charges,75% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,868.41,35,,694.728,percent of total billed charges,35% of total billed charges for outpatient setting,1935.32,78,,1548.256,percent of total billed charges,78% of total billed charges for outpatient setting,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,1736.83,70,,1389.464,percent of total billed charges,70% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1860.89,75,,1488.712,percent of total billed charges,75% of total billed charges for outpatient setting,2059.38,83,,1647.504,percent of total billed charges,83% of total billed charges for outpatient setting,1240.59,50,,992.472,percent of total billed charges,50% of total billed charges for outpatient setting,1240.59,50,,992.472,percent of total billed charges,50% of total billed charges for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.83,39.17,,777.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,869.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,868.41,2059.38,
REMOVAL IMPACTED CERUMEN - syringe irrig,1001175,CDM,450,RC,69209,HCPCS,outpatient,,,170.55,85.28,,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.49,38.4,,52.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.69,35,,47.752,percent of total billed charges,35% of total billed charges for outpatient setting,133.03,78,,106.424,percent of total billed charges,78% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,119.39,70,,95.512,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.91,75,,102.328,percent of total billed charges,75% of total billed charges for outpatient setting,141.56,83,,113.248,percent of total billed charges,83% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,85.28,50,,68.224,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.8,39.17,,53.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,141.56,
GASTROCCULT,1001176,CDM,450,RC,82271,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,5.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,5.32,
CARDIOVERSION,1001177,CDM,450,RC,92960,HCPCS,outpatient,,,1721.19,860.6,,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,660.94,38.4,,528.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,660.94,38.4,,528.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,1290.89,75,,1032.712,percent of total billed charges,75% of total billed charges for outpatient setting,1290.89,75,,1032.712,percent of total billed charges,75% of total billed charges for outpatient setting,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,1290.89,75,,1032.712,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,602.42,35,,481.936,percent of total billed charges,35% of total billed charges for outpatient setting,1342.53,78,,1074.024,percent of total billed charges,78% of total billed charges for outpatient setting,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,1204.83,70,,963.864,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1290.89,75,,1032.712,percent of total billed charges,75% of total billed charges for outpatient setting,1428.59,83,,1142.872,percent of total billed charges,83% of total billed charges for outpatient setting,860.6,50,,688.48,percent of total billed charges,50% of total billed charges for outpatient setting,860.6,50,,688.48,percent of total billed charges,50% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,674.16,39.17,,539.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,1428.59,
CORONARY THROMBOLYSIS INFUSION,1001178,CDM,450,RC,92977,HCPCS,outpatient,,,976.92,488.46,,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,375.14,38.4,,300.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,375.14,38.4,,300.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,341.92,35,,273.536,percent of total billed charges,35% of total billed charges for outpatient setting,762,78,,609.6,percent of total billed charges,78% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,683.84,70,,547.072,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,732.69,75,,586.152,percent of total billed charges,75% of total billed charges for outpatient setting,810.84,83,,648.672,percent of total billed charges,83% of total billed charges for outpatient setting,488.46,50,,390.768,percent of total billed charges,50% of total billed charges for outpatient setting,488.46,50,,390.768,percent of total billed charges,50% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,382.64,39.17,,306.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,810.84,
PACEMAKER INTERROGATION,1001179,CDM,450,RC,93288,HCPCS,outpatient,,,114.09,57.05,,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,32.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,43.81,38.4,,35.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.81,38.4,,35.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,85.57,75,,68.456,percent of total billed charges,75% of total billed charges for outpatient setting,85.57,75,,68.456,percent of total billed charges,75% of total billed charges for outpatient setting,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,85.57,75,,68.456,percent of total billed charges,75% of total billed charges for outpatient setting,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.93,35,,31.944,percent of total billed charges,35% of total billed charges for outpatient setting,88.99,78,,71.192,percent of total billed charges,78% of total billed charges for outpatient setting,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,79.86,70,,63.888,percent of total billed charges,70% of total billed charges for outpatient setting,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.57,75,,68.456,percent of total billed charges,75% of total billed charges for outpatient setting,94.69,83,,75.752,percent of total billed charges,83% of total billed charges for outpatient setting,57.05,50,,45.64,percent of total billed charges,50% of total billed charges for outpatient setting,57.05,50,,45.64,percent of total billed charges,50% of total billed charges for outpatient setting,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.69,39.17,,35.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,32.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.39,94.69,
BB DIRECT COOMBS,1110315,CDM,300,RC,86880,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,52.54,
BB ANTIBODY SCREEN,1110320,CDM,300,RC,86850,HCPCS,outpatient,,,44.12,22.06,,30.88,70,,24.704,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.41,78,,27.528,percent of total billed charges,78% of total billed charges for outpatient setting,30.88,70,,24.704,percent of total billed charges,70% of total billed charges for outpatient setting,30.88,70,,24.704,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.09,75,,26.472,percent of total billed charges,75% of total billed charges for outpatient setting,36.62,83,,29.296,percent of total billed charges,83% of total billed charges for outpatient setting,22.06,50,,17.648,percent of total billed charges,50% of total billed charges for outpatient setting,22.06,50,,17.648,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.77,46.54,
BB PLATELETS PER UNIT,1110644,CDM,390,RC,P9019,HCPCS,outpatient,,,364,182,,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,65.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.4,35,,101.92,percent of total billed charges,35% of total billed charges for outpatient setting,283.92,78,,227.136,percent of total billed charges,78% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,302.12,83,,241.696,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.58,39.17,,114.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,65.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.04,424,
BB PLASMA PER UNIT-FFP,1110645,CDM,390,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
BB CROSSMATCH,1170588,CDM,390,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
BB FMH - ROSETTE,1170610,CDM,300,RC,85461,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,9.36,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,23.24,
BB RHIG,1170612,CDM,300,RC,90384,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.65,35,,38.92,percent of total billed charges,35% of total billed charges for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.45,39.17,,43.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,48.65,115.37,
BB KLEIHAUER BETKE,1170620,CDM,300,RC,85460,HCPCS,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.55,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.13,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.13,9.55,
BB PLATELET PHERESIS LEUCO,1170626,CDM,390,RC,P9035,HCPCS,outpatient,,,1543,771.5,,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,472.33,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,592.51,38.4,,474.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.51,38.4,,474.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,1157.25,75,,925.8,percent of total billed charges,75% of total billed charges for outpatient setting,1157.25,75,,925.8,percent of total billed charges,75% of total billed charges for outpatient setting,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,1157.25,75,,925.8,percent of total billed charges,75% of total billed charges for outpatient setting,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,540.05,35,,432.04,percent of total billed charges,35% of total billed charges for outpatient setting,1203.54,78,,962.832,percent of total billed charges,78% of total billed charges for outpatient setting,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,1080.1,70,,864.08,percent of total billed charges,70% of total billed charges for outpatient setting,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1157.25,75,,925.8,percent of total billed charges,75% of total billed charges for outpatient setting,1280.69,83,,1024.552,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.36,39.17,,483.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,472.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424,1280.69,
BB PROCESSING UNIT PC LR,1170672,CDM,390,RC,P9016,HCPCS,outpatient,,,589,294.5,,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,226.18,38.4,,180.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,226.18,38.4,,180.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,206.15,35,,164.92,percent of total billed charges,35% of total billed charges for outpatient setting,459.42,78,,367.536,percent of total billed charges,78% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,488.87,83,,391.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.7,39.17,,184.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,488.87,
BB FILTER-PACKED CELLS,1170674,CDM,272,RC,,,outpatient,,,28.7,14.35,,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.02,38.4,,8.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.02,38.4,,8.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.05,35,,8.04,percent of total billed charges,35% of total billed charges for outpatient setting,22.39,78,,17.912,percent of total billed charges,78% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,23.82,83,,19.056,percent of total billed charges,83% of total billed charges for outpatient setting,14.35,50,,11.48,percent of total billed charges,50% of total billed charges for outpatient setting,14.35,50,,11.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.24,39.17,,8.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.05,23.82,
BB CRYO PER UNIT,1170675,CDM,390,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
BB FILTER-FFP,1170676,CDM,272,RC,,,outpatient,,,29.4,14.7,,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.29,35,,8.232,percent of total billed charges,35% of total billed charges for outpatient setting,22.93,78,,18.344,percent of total billed charges,78% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,24.4,83,,19.52,percent of total billed charges,83% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,39.17,,9.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.29,24.4,
BB FILTER-PLT,1170732,CDM,272,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
BB FILTER-CRYO,1170733,CDM,272,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
BB DIRECTED DONOR UNIT PC,1170845,CDM,300,RC,86890,HCPCS,outpatient,,,187,93.5,,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,71.81,38.4,,57.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.81,38.4,,57.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,140.25,75,,112.2,percent of total billed charges,75% of total billed charges for outpatient setting,140.25,75,,112.2,percent of total billed charges,75% of total billed charges for outpatient setting,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,140.25,75,,112.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.45,35,,52.36,percent of total billed charges,35% of total billed charges for outpatient setting,145.86,78,,116.688,percent of total billed charges,78% of total billed charges for outpatient setting,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,130.9,70,,104.72,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.25,75,,112.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.21,83,,124.168,percent of total billed charges,83% of total billed charges for outpatient setting,93.5,50,,74.8,percent of total billed charges,50% of total billed charges for outpatient setting,93.5,50,,74.8,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.25,39.17,,58.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.45,155.21,
BB PLASMA PER UNIT-FFP (B),1175099,CDM,390,RC,86927,HCPCS,outpatient,,,459.2,229.6,,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,176.33,38.4,,141.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,176.33,38.4,,141.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,344.4,75,,275.52,percent of total billed charges,75% of total billed charges for outpatient setting,344.4,75,,275.52,percent of total billed charges,75% of total billed charges for outpatient setting,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,344.4,75,,275.52,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.72,35,,128.576,percent of total billed charges,35% of total billed charges for outpatient setting,358.18,78,,286.544,percent of total billed charges,78% of total billed charges for outpatient setting,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,321.44,70,,257.152,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,344.4,75,,275.52,percent of total billed charges,75% of total billed charges for outpatient setting,381.14,83,,304.912,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,179.86,39.17,,143.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,424,
BB PLASMA PER UNIT-FFP (B),1175100,CDM,390,RC,P9017,HCPCS,outpatient,,,341.6,170.8,,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,79.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,131.17,38.4,,104.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,131.17,38.4,,104.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,256.2,75,,204.96,percent of total billed charges,75% of total billed charges for outpatient setting,256.2,75,,204.96,percent of total billed charges,75% of total billed charges for outpatient setting,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,256.2,75,,204.96,percent of total billed charges,75% of total billed charges for outpatient setting,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.56,35,,95.648,percent of total billed charges,35% of total billed charges for outpatient setting,266.45,78,,213.16,percent of total billed charges,78% of total billed charges for outpatient setting,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,239.12,70,,191.296,percent of total billed charges,70% of total billed charges for outpatient setting,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.2,75,,204.96,percent of total billed charges,75% of total billed charges for outpatient setting,283.53,83,,226.824,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133.79,39.17,,107.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,79.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.95,424,
BB TYPE & RH (B),1175327,CDM,300,RC,86900,HCPCS,outpatient,,,102.18,51.09,,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.7,78,,63.76,percent of total billed charges,78% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,84.81,83,,67.848,percent of total billed charges,83% of total billed charges for outpatient setting,51.09,50,,40.872,percent of total billed charges,50% of total billed charges for outpatient setting,51.09,50,,40.872,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,109.72,
BB TYPE & RH (B),1175328,CDM,300,RC,86901,HCPCS,outpatient,,,29.88,14.94,,20.92,70,,16.736,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.31,78,,18.648,percent of total billed charges,78% of total billed charges for outpatient setting,20.92,70,,16.736,percent of total billed charges,70% of total billed charges for outpatient setting,20.92,70,,16.736,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.41,75,,17.928,percent of total billed charges,75% of total billed charges for outpatient setting,24.8,83,,19.84,percent of total billed charges,83% of total billed charges for outpatient setting,14.94,50,,11.952,percent of total billed charges,50% of total billed charges for outpatient setting,14.94,50,,11.952,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.69,34.44,
BB CROSSMATCH (B),1175470,CDM,390,RC,86900,HCPCS,outpatient,,,102.18,51.09,,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.7,78,,63.76,percent of total billed charges,78% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,84.81,83,,67.848,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,424,
BB CROSSMATCH (B),1175471,CDM,390,RC,86920,HCPCS,outpatient,,,138.38,69.19,,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.43,35,,38.744,percent of total billed charges,35% of total billed charges for outpatient setting,107.94,78,,86.352,percent of total billed charges,78% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.79,75,,83.032,percent of total billed charges,75% of total billed charges for outpatient setting,114.86,83,,91.888,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.2,39.17,,43.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.33,424,
BB CROSSMATCH (B),1175472,CDM,390,RC,86921,HCPCS,outpatient,,,138.38,69.19,,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.43,35,,38.744,percent of total billed charges,35% of total billed charges for outpatient setting,107.94,78,,86.352,percent of total billed charges,78% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.79,75,,83.032,percent of total billed charges,75% of total billed charges for outpatient setting,114.86,83,,91.888,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.2,39.17,,43.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.1,424,
BB CROSSMATCH (B),1175473,CDM,390,RC,86922,HCPCS,outpatient,,,138.38,69.19,,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.14,38.4,,42.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.43,35,,38.744,percent of total billed charges,35% of total billed charges for outpatient setting,107.94,78,,86.352,percent of total billed charges,78% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,96.87,70,,77.496,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.79,75,,83.032,percent of total billed charges,75% of total billed charges for outpatient setting,114.86,83,,91.888,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.2,39.17,,43.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.6,424,
BB CRYO PER UNIT (B),1175512,CDM,390,RC,86927,HCPCS,outpatient,,,458,229,,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.3,35,,128.24,percent of total billed charges,35% of total billed charges for outpatient setting,357.24,78,,285.792,percent of total billed charges,78% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,380.14,83,,304.112,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,179.39,39.17,,143.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,424,
BB CRYO PER UNIT (B),1175514,CDM,390,RC,P9012,HCPCS,outpatient,,,284,142,,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,59.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.06,38.4,,87.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.06,38.4,,87.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.4,35,,79.52,percent of total billed charges,35% of total billed charges for outpatient setting,221.52,78,,177.216,percent of total billed charges,78% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,198.8,70,,159.04,percent of total billed charges,70% of total billed charges for outpatient setting,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213,75,,170.4,percent of total billed charges,75% of total billed charges for outpatient setting,235.72,83,,188.576,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.24,39.17,,88.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,59.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.87,424,
BB ANTIBODY PANEL (B),1175645,CDM,300,RC,86900,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,109.72,
BB ANTIBODY PANEL (B),1175646,CDM,300,RC,86901,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.69,34.44,
BB ANTIBODY PANEL (B),1175647,CDM,300,RC,86850,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.77,46.54,
BB ANTIBODY PANEL (B),1175648,CDM,300,RC,86870,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,308.75,
BB ANTIBODY PANEL (B),1175649,CDM,300,RC,86906,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,34.44,
BB ANTIBODY PANEL (B),1175650,CDM,300,RC,80500,HCPCS,outpatient,,,114,57,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.9,35,,31.92,percent of total billed charges,35% of total billed charges for outpatient setting,88.92,78,,71.136,percent of total billed charges,78% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,94.62,83,,75.696,percent of total billed charges,83% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.66,39.17,,35.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.9,94.62,
BB RHIG WORKUP (OB) (B),1176566,CDM,300,RC,86850,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.77,46.54,
BB RHIG WORKUP (OB) (B),1176567,CDM,300,RC,86900,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,109.72,
BB RHIG WORKUP (OB) (B),1176568,CDM,300,RC,86901,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.69,34.44,
BB ANTIGEN TYPING,1178875,CDM,300,RC,86905,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
BB PROCESSING UNIT PC LEUCOREDUCE,1178887,CDM,390,RC,P9016,HCPCS,outpatient,,,497.12,248.56,,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,190.89,38.4,,152.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.89,38.4,,152.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,372.84,75,,298.272,percent of total billed charges,75% of total billed charges for outpatient setting,372.84,75,,298.272,percent of total billed charges,75% of total billed charges for outpatient setting,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,372.84,75,,298.272,percent of total billed charges,75% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,173.99,35,,139.192,percent of total billed charges,35% of total billed charges for outpatient setting,387.75,78,,310.2,percent of total billed charges,78% of total billed charges for outpatient setting,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,347.98,70,,278.384,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.84,75,,298.272,percent of total billed charges,75% of total billed charges for outpatient setting,412.61,83,,330.088,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,194.71,39.17,,155.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,173.99,424,
BB PHENOTYPE,1179107,CDM,300,RC,86905,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
BB RH PHENOTYPE COMPLETE,1179150,CDM,300,RC,86906,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,34.44,
BB PRETREATMENT WITH ENZYMES PER,1179151,CDM,300,RC,86971,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,146.71,
BB PROCESSING UNIT ALYX PC,1179157,CDM,390,RC,P9016,HCPCS,outpatient,,,589,294.5,,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,226.18,38.4,,180.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,226.18,38.4,,180.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,206.15,35,,164.92,percent of total billed charges,35% of total billed charges for outpatient setting,459.42,78,,367.536,percent of total billed charges,78% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,412.3,70,,329.84,percent of total billed charges,70% of total billed charges for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,441.75,75,,353.4,percent of total billed charges,75% of total billed charges for outpatient setting,488.87,83,,391.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.7,39.17,,184.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,180.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.82,488.87,
BB IRRADIATION OF PLTS,1179178,CDM,390,RC,P9036,HCPCS,outpatient,,,1804,902,,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,559.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,692.74,38.4,,554.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,692.74,38.4,,554.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,1353,75,,1082.4,percent of total billed charges,75% of total billed charges for outpatient setting,1353,75,,1082.4,percent of total billed charges,75% of total billed charges for outpatient setting,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,1353,75,,1082.4,percent of total billed charges,75% of total billed charges for outpatient setting,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,631.4,35,,505.12,percent of total billed charges,35% of total billed charges for outpatient setting,1407.12,78,,1125.696,percent of total billed charges,78% of total billed charges for outpatient setting,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,1262.8,70,,1010.24,percent of total billed charges,70% of total billed charges for outpatient setting,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1353,75,,1082.4,percent of total billed charges,75% of total billed charges for outpatient setting,1497.32,83,,1197.856,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,706.59,39.17,,565.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424,1497.32,
BB IRRADIATION OF PC,1179179,CDM,390,RC,P9038,HCPCS,outpatient,,,678,339,,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,216.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,260.35,38.4,,208.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,260.35,38.4,,208.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,237.3,35,,189.84,percent of total billed charges,35% of total billed charges for outpatient setting,528.84,78,,423.072,percent of total billed charges,78% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,562.74,83,,450.192,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.56,39.17,,212.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,216.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216.72,562.74,
BB AFTER HOURS SBC,1179183,CDM,380,RC,,,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,424,
BB RH PHENOTYPE,1179197,CDM,300,RC,86906,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,34.44,
BB TITRATION STUDIES,1179198,CDM,300,RC,86886,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,146.71,
BB AB ID/EACH PANEL & MEDIA,1192414,CDM,380,RC,86870,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,424,
URINALYSIS,1200000,CDM,300,RC,81001,HCPCS,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,3.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.79,9.13,
OCCULT BLOOD,1200001,CDM,300,RC,82272,HCPCS,outpatient,,,19.41,9.71,,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,15.14,78,,12.112,percent of total billed charges,78% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,16.11,83,,12.888,percent of total billed charges,83% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,16.11,
CALCIUM,1200002,CDM,300,RC,82310,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,30.71,
GLUCOSE SERUM,1200003,CDM,300,RC,82947,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,22.41,
PHOSPHORUS,1200004,CDM,300,RC,84100,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.18,27.39,
POTASSIUM,1200005,CDM,300,RC,84132,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,26.56,
BUN,1200006,CDM,300,RC,84520,HCPCS,outpatient,,,39.2,19.6,,27.44,70,,21.952,percent of total billed charges,70% of total billed charges for outpatient setting,3.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.58,78,,24.464,percent of total billed charges,78% of total billed charges for outpatient setting,27.44,70,,21.952,percent of total billed charges,70% of total billed charges for outpatient setting,27.44,70,,21.952,percent of total billed charges,70% of total billed charges for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,75,,23.52,percent of total billed charges,75% of total billed charges for outpatient setting,32.54,83,,26.032,percent of total billed charges,83% of total billed charges for outpatient setting,19.6,50,,15.68,percent of total billed charges,50% of total billed charges for outpatient setting,19.6,50,,15.68,percent of total billed charges,50% of total billed charges for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.47,32.54,
HEMATOCRIT,1200007,CDM,300,RC,85014,HCPCS,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,13.28,
HEMOGLOBIN,1200008,CDM,300,RC,85018,HCPCS,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,13.28,
CBC/PLT & DIFF,1200009,CDM,300,RC,85025,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,43.99,
PROTHROMBIN TIME,1200011,CDM,300,RC,85610,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,11.62,
SED RATE,1200012,CDM,300,RC,85651,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.46,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.46,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.12,19.92,
PTT,1200013,CDM,300,RC,85730,HCPCS,outpatient,,,36.29,18.15,,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.31,78,,22.648,percent of total billed charges,78% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,30.12,83,,24.096,percent of total billed charges,83% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,30.12,
BLOOD CULTURE,1200014,CDM,300,RC,87040,HCPCS,outpatient,,,62.46,31.23,,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,46.85,75,,37.48,percent of total billed charges,75% of total billed charges for outpatient setting,46.85,75,,37.48,percent of total billed charges,75% of total billed charges for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,46.85,75,,37.48,percent of total billed charges,75% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,48.72,78,,38.976,percent of total billed charges,78% of total billed charges for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,43.72,70,,34.976,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.85,75,,37.48,percent of total billed charges,75% of total billed charges for outpatient setting,51.84,83,,41.472,percent of total billed charges,83% of total billed charges for outpatient setting,31.23,50,,24.984,percent of total billed charges,50% of total billed charges for outpatient setting,31.23,50,,24.984,percent of total billed charges,50% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,51.84,
STOOL CULTURE,1200015,CDM,300,RC,87045,HCPCS,outpatient,,,93.8,46.9,,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.02,38.4,,28.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.02,38.4,,28.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.83,35,,26.264,percent of total billed charges,35% of total billed charges for outpatient setting,73.16,78,,58.528,percent of total billed charges,78% of total billed charges for outpatient setting,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.35,75,,56.28,percent of total billed charges,75% of total billed charges for outpatient setting,77.85,83,,62.28,percent of total billed charges,83% of total billed charges for outpatient setting,46.9,50,,37.52,percent of total billed charges,50% of total billed charges for outpatient setting,46.9,50,,37.52,percent of total billed charges,50% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.74,39.17,,29.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,77.85,
SPUTUM CULTURE,1200017,CDM,300,RC,87070,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,48.97,
CRP,1200018,CDM,300,RC,86140,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,29.88,
CULTURE AEROBIC,1200019,CDM,300,RC,87070,HCPCS,outpatient,,,51.48,25.74,,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.15,78,,32.12,percent of total billed charges,78% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,42.73,83,,34.184,percent of total billed charges,83% of total billed charges for outpatient setting,25.74,50,,20.592,percent of total billed charges,50% of total billed charges for outpatient setting,25.74,50,,20.592,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,42.73,
ANAEROBIC CULTURE,1200020,CDM,300,RC,87075,HCPCS,outpatient,,,56.55,28.28,,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,9.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,42.41,75,,33.928,percent of total billed charges,75% of total billed charges for outpatient setting,42.41,75,,33.928,percent of total billed charges,75% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,42.41,75,,33.928,percent of total billed charges,75% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.11,78,,35.288,percent of total billed charges,78% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.41,75,,33.928,percent of total billed charges,75% of total billed charges for outpatient setting,46.94,83,,37.552,percent of total billed charges,83% of total billed charges for outpatient setting,28.28,50,,22.624,percent of total billed charges,50% of total billed charges for outpatient setting,28.28,50,,22.624,percent of total billed charges,50% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.33,46.94,
URINE CULTURE,1200021,CDM,300,RC,87088,HCPCS,outpatient,,,48.95,24.48,,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,8.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.18,78,,30.544,percent of total billed charges,78% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,40.63,83,,32.504,percent of total billed charges,83% of total billed charges for outpatient setting,24.48,50,,19.584,percent of total billed charges,50% of total billed charges for outpatient setting,24.48,50,,19.584,percent of total billed charges,50% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.13,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.13,40.63,
ORGANISM ID,1200022,CDM,300,RC,87077,HCPCS,outpatient,,,48.95,24.48,,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.18,78,,30.544,percent of total billed charges,78% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,34.27,70,,27.416,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.71,75,,29.368,percent of total billed charges,75% of total billed charges for outpatient setting,40.63,83,,32.504,percent of total billed charges,83% of total billed charges for outpatient setting,24.48,50,,19.584,percent of total billed charges,50% of total billed charges for outpatient setting,24.48,50,,19.584,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,40.63,
ORGANISM SENS,1200023,CDM,300,RC,87186,HCPCS,outpatient,,,51.48,25.74,,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.15,78,,32.12,percent of total billed charges,78% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,36.04,70,,28.832,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.61,75,,30.888,percent of total billed charges,75% of total billed charges for outpatient setting,42.73,83,,34.184,percent of total billed charges,83% of total billed charges for outpatient setting,25.74,50,,20.592,percent of total billed charges,50% of total billed charges for outpatient setting,25.74,50,,20.592,percent of total billed charges,50% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,42.73,
URINALYSIS W/O MICRO,1200024,CDM,300,RC,81003,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.97,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.98,12.45,
GRAM STAIN,1200025,CDM,300,RC,87205,HCPCS,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,13.28,
BF CELL CT & DIFF,1200026,CDM,300,RC,89050,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.17,28.22,
DIGOXIN,1200027,CDM,300,RC,80162,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.54,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.69,75.53,
DILANTIN,1200028,CDM,300,RC,80185,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,75.53,
AMYLASE,1200030,CDM,300,RC,82150,HCPCS,outpatient,,,39.67,19.84,,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.94,78,,24.752,percent of total billed charges,78% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.93,83,,26.344,percent of total billed charges,83% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,32.93,
ELECTROLYTE PANEL,1200031,CDM,300,RC,80051,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,7.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.17,39.84,
FECAL LEUCOCYTES,1200032,CDM,300,RC,87210,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,34.86,
SODIUM,1200033,CDM,300,RC,84295,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.35,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,27.39,
CREATININE,1200034,CDM,300,RC,82565,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,29.05,
CHLORIDE,1200035,CDM,300,RC,82435,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,26.56,
ALBUMIN,1200036,CDM,300,RC,82040,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,4.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,17.43,
URINE CREATININE,1200037,CDM,300,RC,82570,HCPCS,outpatient,,,53.2,26.6,,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,41.5,78,,33.2,percent of total billed charges,78% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,83,,35.328,percent of total billed charges,83% of total billed charges for outpatient setting,26.6,50,,21.28,percent of total billed charges,50% of total billed charges for outpatient setting,26.6,50,,21.28,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,44.16,
URINE PROTEIN,1200038,CDM,300,RC,84155,HCPCS,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,20.75,
UREA URINE,1200039,CDM,300,RC,84540,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
MANUAL PLATELET,1200040,CDM,300,RC,85032,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,24.9,
ALCOHOL,1200041,CDM,300,RC,80320,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.51,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.51,61.42,
FIBRINOGEN,1200042,CDM,300,RC,85384,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.48,49.8,
LIVER PROFILE,1200043,CDM,300,RC,80076,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,46.48,
GGT,1200044,CDM,300,RC,82977,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,43.16,
LDH,1200045,CDM,300,RC,83615,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,34.86,
CO2,1200046,CDM,300,RC,82374,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,28.22,
VANCOMYCIN,1200047,CDM,300,RC,80202,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,64.74,
LIPASE,1200048,CDM,300,RC,83690,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,39.01,
LIPID PROFILE,1200049,CDM,300,RC,80061,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.8,76.36,
MAGNESIUM,1200050,CDM,300,RC,83735,HCPCS,outpatient,,,20.26,10.13,,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,15.8,78,,12.64,percent of total billed charges,78% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,16.82,83,,13.456,percent of total billed charges,83% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,16.82,
BNP,1200051,CDM,300,RC,83880,HCPCS,outpatient,,,233,116.5,,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,181.74,78,,145.392,percent of total billed charges,78% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.39,83,,154.712,percent of total billed charges,83% of total billed charges for outpatient setting,116.5,50,,93.2,percent of total billed charges,50% of total billed charges for outpatient setting,116.5,50,,93.2,percent of total billed charges,50% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,193.39,
THROAT CULT(B),1200054,CDM,300,RC,87070,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,48.97,
THROAT CULT(B),1200055,CDM,300,RC,87077,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,46.48,
CK TOTAL,1200056,CDM,300,RC,82550,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,37.35,
CKMB,1200057,CDM,300,RC,82553,HCPCS,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,65.57,
TROPONIN,1200058,CDM,300,RC,84484,HCPCS,outpatient,,,59.08,29.54,,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.08,78,,36.864,percent of total billed charges,78% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,49.04,83,,39.232,percent of total billed charges,83% of total billed charges for outpatient setting,29.54,50,,23.632,percent of total billed charges,50% of total billed charges for outpatient setting,29.54,50,,23.632,percent of total billed charges,50% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,49.04,
TSH,1200059,CDM,300,RC,84443,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,69.72,
DEPAKOTE/VAL ACID,1200060,CDM,300,RC,80164,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,64.74,
IRON,1200061,CDM,300,RC,83540,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,37.35,
MONO SPOT,1200062,CDM,300,RC,86308,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,29.88,
COMPREHENSIVE PANEL,1200063,CDM,300,RC,80053,HCPCS,outpatient,,,102.2,51.1,,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,10.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,76.65,75,,61.32,percent of total billed charges,75% of total billed charges for outpatient setting,76.65,75,,61.32,percent of total billed charges,75% of total billed charges for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,76.65,75,,61.32,percent of total billed charges,75% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.95,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.72,78,,63.776,percent of total billed charges,78% of total billed charges for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,71.54,70,,57.232,percent of total billed charges,70% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,75,,61.32,percent of total billed charges,75% of total billed charges for outpatient setting,84.83,83,,67.864,percent of total billed charges,83% of total billed charges for outpatient setting,51.1,50,,40.88,percent of total billed charges,50% of total billed charges for outpatient setting,51.1,50,,40.88,percent of total billed charges,50% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,84.83,
FOLIC ACID,1200064,CDM,300,RC,82746,HCPCS,outpatient,,,101,50.5,,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78.78,78,,63.024,percent of total billed charges,78% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.83,83,,67.064,percent of total billed charges,83% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,83.83,
CBC W/O DIFF,1200065,CDM,300,RC,85027,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,110.39,
ACETONE QUAN,1210001,CDM,300,RC,82010,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,48.14,
AMINO ACID PLASMA SCREEN,1210004,CDM,300,RC,82139,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
RUBELLA IGG,1210012,CDM,300,RC,86762,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
"ADM-PC,FFP,PLT,CRYO",1210023,CDM,391,RC,36430,HCPCS,outpatient,,,1426,713,,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,547.58,38.4,,438.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,547.58,38.4,,438.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,1069.5,75,,855.6,percent of total billed charges,75% of total billed charges for outpatient setting,1069.5,75,,855.6,percent of total billed charges,75% of total billed charges for outpatient setting,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,1069.5,75,,855.6,percent of total billed charges,75% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,499.1,35,,399.28,percent of total billed charges,35% of total billed charges for outpatient setting,1112.28,78,,889.824,percent of total billed charges,78% of total billed charges for outpatient setting,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,998.2,70,,798.56,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1069.5,75,,855.6,percent of total billed charges,75% of total billed charges for outpatient setting,1183.58,83,,946.864,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,558.53,39.17,,446.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,1183.58,
AMMONIA,1210026,CDM,300,RC,82140,HCPCS,outpatient,,,29.54,14.77,,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.44,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.44,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.06,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.04,78,,18.432,percent of total billed charges,78% of total billed charges for outpatient setting,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,75,,17.728,percent of total billed charges,75% of total billed charges for outpatient setting,24.52,83,,19.616,percent of total billed charges,83% of total billed charges for outpatient setting,14.77,50,,11.816,percent of total billed charges,50% of total billed charges for outpatient setting,14.77,50,,11.816,percent of total billed charges,50% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.71,24.52,
ALB TEST,1210030,CDM,300,RC,82040,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,4.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,11.62,
AMINO ACID URINE SCR,1210034,CDM,300,RC,82139,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
ANTI-THYROGLOBIN AB,1210040,CDM,300,RC,86800,HCPCS,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,47.31,
ALKALINE PHOSPHATASE,1210045,CDM,300,RC,84075,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,31.54,
PROLACTIN,1210052,CDM,300,RC,84146,HCPCS,outpatient,,,69,34.5,,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,19.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,53.82,78,,43.056,percent of total billed charges,78% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,57.27,83,,45.816,percent of total billed charges,83% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.06,57.27,
THY.BINDING GLOB.,1210054,CDM,300,RC,84442,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
AMYLASE SERUM,1210060,CDM,300,RC,82150,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,109.56,
AMYLASE URINE,1210061,CDM,300,RC,82150,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,19.92,
ANA SCREEN,1210065,CDM,300,RC,86038,HCPCS,outpatient,,,200,100,,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,156,78,,124.8,percent of total billed charges,78% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,166,83,,132.8,percent of total billed charges,83% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,166,
ASO TITER,1210070,CDM,300,RC,86060,HCPCS,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,7.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.15,20.75,
VIT B-12,1210075,CDM,300,RC,82607,HCPCS,outpatient,,,45.58,22.79,,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,34.19,75,,27.352,percent of total billed charges,75% of total billed charges for outpatient setting,34.19,75,,27.352,percent of total billed charges,75% of total billed charges for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,34.19,75,,27.352,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.55,78,,28.44,percent of total billed charges,78% of total billed charges for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,31.91,70,,25.528,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.19,75,,27.352,percent of total billed charges,75% of total billed charges for outpatient setting,37.83,83,,30.264,percent of total billed charges,83% of total billed charges for outpatient setting,22.79,50,,18.232,percent of total billed charges,50% of total billed charges for outpatient setting,22.79,50,,18.232,percent of total billed charges,50% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,37.83,
COMPLEMENT C3,1210081,CDM,300,RC,86160,HCPCS,outpatient,,,61.6,30.8,,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,48.05,78,,38.44,percent of total billed charges,78% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,51.13,83,,40.904,percent of total billed charges,83% of total billed charges for outpatient setting,30.8,50,,24.64,percent of total billed charges,50% of total billed charges for outpatient setting,30.8,50,,24.64,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,51.13,
ARSENIC URINE,1210082,CDM,300,RC,82175,HCPCS,outpatient,,,134,67,,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,104.52,78,,83.616,percent of total billed charges,78% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.22,83,,88.976,percent of total billed charges,83% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,111.22,
COMPLEMENT TOTAL,1210085,CDM,300,RC,86162,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,60.59,
HAPTOGLOBIN,1210095,CDM,300,RC,83010,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.28,12.58,
THYROID STIM HARMONE,1210105,CDM,300,RC,84443,HCPCS,outpatient,,,192,96,,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,144,75,,115.2,percent of total billed charges,75% of total billed charges for outpatient setting,144,75,,115.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,144,75,,115.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,149.76,78,,119.808,percent of total billed charges,78% of total billed charges for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,134.4,70,,107.52,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144,75,,115.2,percent of total billed charges,75% of total billed charges for outpatient setting,159.36,83,,127.488,percent of total billed charges,83% of total billed charges for outpatient setting,96,50,,76.8,percent of total billed charges,50% of total billed charges for outpatient setting,96,50,,76.8,percent of total billed charges,50% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,159.36,
PSA,1210106,CDM,300,RC,84153,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,75.53,
CORTISOL URINE FREE,1210108,CDM,300,RC,82530,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,49.8,
TOBRAMYCIN PEAK,1210109,CDM,300,RC,80200,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,16.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.78,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,87.98,
TOTAL BILIRUBIN,1210110,CDM,300,RC,82247,HCPCS,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,5.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,58.93,
ACTH,1210114,CDM,300,RC,82024,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,48.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,38.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34,113.71,
BLEEDING TIME (IVY),1210120,CDM,300,RC,85002,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.96,19.09,
ZINC,1210123,CDM,300,RC,84630,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.02,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.02,34.03,
SELENIUM,1210124,CDM,300,RC,84255,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.71,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.47,75.53,
VANCOMYCIN PEAK,1210128,CDM,300,RC,80202,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,140.27,
VANCOMYCIN TROUGH,1210129,CDM,300,RC,80202,HCPCS,outpatient,,,142.64,71.32,,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,111.26,78,,89.008,percent of total billed charges,78% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,118.39,83,,94.712,percent of total billed charges,83% of total billed charges for outpatient setting,71.32,50,,57.056,percent of total billed charges,50% of total billed charges for outpatient setting,71.32,50,,57.056,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,118.39,
ALCOHOL,1210130,CDM,300,RC,80320,HCPCS,outpatient,,,32.92,16.46,,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.68,78,,20.544,percent of total billed charges,78% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,27.32,83,,21.856,percent of total billed charges,83% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.51,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.51,27.32,
LEAD,1210140,CDM,300,RC,83655,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,104.58,
GENTAMYCIN PEAK,1210141,CDM,300,RC,80170,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,48.97,
GENTAMYCIN TROUGH,1210142,CDM,300,RC,80170,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,48.97,
TEGRETOL,1210143,CDM,300,RC,80156,HCPCS,outpatient,,,260,130,,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,202.8,78,,162.24,percent of total billed charges,78% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,83,,172.64,percent of total billed charges,83% of total billed charges for outpatient setting,130,50,,104,percent of total billed charges,50% of total billed charges for outpatient setting,130,50,,104,percent of total billed charges,50% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.82,215.8,
ETHOSUZIMIDE,1210144,CDM,300,RC,80168,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.58,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,48.14,
IGG,1210145,CDM,300,RC,82784,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,27.39,
METANEPHRINES URINE,1210150,CDM,300,RC,83835,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,49.8,
CHLAMYDIA CULTURE,1210152,CDM,300,RC,87110,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,24.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.24,58.1,
TESTOSTERONE,1210153,CDM,300,RC,84403,HCPCS,outpatient,,,410.2,205.1,,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,307.65,75,,246.12,percent of total billed charges,75% of total billed charges for outpatient setting,307.65,75,,246.12,percent of total billed charges,75% of total billed charges for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,307.65,75,,246.12,percent of total billed charges,75% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,319.96,78,,255.968,percent of total billed charges,78% of total billed charges for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,287.14,70,,229.712,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.65,75,,246.12,percent of total billed charges,75% of total billed charges for outpatient setting,340.47,83,,272.376,percent of total billed charges,83% of total billed charges for outpatient setting,205.1,50,,164.08,percent of total billed charges,50% of total billed charges for outpatient setting,205.1,50,,164.08,percent of total billed charges,50% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,340.47,
RBC FOLATE,1210158,CDM,300,RC,82746,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,86.32,
BUN,1210165,CDM,300,RC,84520,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.47,66.4,
ALPHA FETO PROTEIN,1210166,CDM,300,RC,82105,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,16.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.77,207.5,
ESTRONE,1210169,CDM,300,RC,82679,HCPCS,outpatient,,,177,88.5,,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,24.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,138.06,78,,110.448,percent of total billed charges,78% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.91,83,,117.528,percent of total billed charges,83% of total billed charges for outpatient setting,88.5,50,,70.8,percent of total billed charges,50% of total billed charges for outpatient setting,88.5,50,,70.8,percent of total billed charges,50% of total billed charges for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.97,146.91,
CALCIUM,1210170,CDM,300,RC,82310,HCPCS,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,20.75,
ESTROGEN,1210172,CDM,300,RC,82672,HCPCS,outpatient,,,118,59,,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,92.04,78,,73.632,percent of total billed charges,78% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,97.94,83,,78.352,percent of total billed charges,83% of total billed charges for outpatient setting,59,50,,47.2,percent of total billed charges,50% of total billed charges for outpatient setting,59,50,,47.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.66,97.94,
HERPES SIMP VIR ANTI,1210173,CDM,300,RC,86694,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
QUANT HCG BETA HCG,1210174,CDM,300,RC,84702,HCPCS,outpatient,,,187.6,93.8,,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,146.33,78,,117.064,percent of total billed charges,78% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,155.71,83,,124.568,percent of total billed charges,83% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,155.71,
CAROTENE,1210180,CDM,300,RC,82380,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,9.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.12,53.95,
TOXOCARA IGG,1210194,CDM,300,RC,86317,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,71.38,
CHLORIDE,1210195,CDM,300,RC,82435,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,27.39,
GLUCOSE,1210196,CDM,300,RC,82947,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,12.45,
CHOLESTEROL,1210200,CDM,300,RC,82465,HCPCS,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,4.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.83,18.26,
CHOLINESTERASE,1210201,CDM,300,RC,82480,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,7.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.91,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.91,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.94,46.48,
TOXOCARA ANTI IGM,1210203,CDM,300,RC,86317,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,71.38,
TRICHONELLA AB,1210204,CDM,300,RC,86784,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.06,73.87,
CO2,1210305,CDM,300,RC,82374,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,14.94,
CORTISOL SERUM RIA,1210321,CDM,300,RC,82533,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.53,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.35,48.14,
SENSITIVITY,1210326,CDM,300,RC,87186,HCPCS,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,25.73,
STAPH COAG,1210327,CDM,300,RC,87077,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,48.14,
CRP,1210330,CDM,300,RC,86140,HCPCS,outpatient,,,152.6,76.3,,106.82,70,,85.456,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,119.03,78,,95.224,percent of total billed charges,78% of total billed charges for outpatient setting,106.82,70,,85.456,percent of total billed charges,70% of total billed charges for outpatient setting,106.82,70,,85.456,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.45,75,,91.56,percent of total billed charges,75% of total billed charges for outpatient setting,126.66,83,,101.328,percent of total billed charges,83% of total billed charges for outpatient setting,76.3,50,,61.04,percent of total billed charges,50% of total billed charges for outpatient setting,76.3,50,,61.04,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,126.66,
CREATININE,1210335,CDM,300,RC,82565,HCPCS,outpatient,,,144.2,72.1,,100.94,70,,80.752,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,112.48,78,,89.984,percent of total billed charges,78% of total billed charges for outpatient setting,100.94,70,,80.752,percent of total billed charges,70% of total billed charges for outpatient setting,100.94,70,,80.752,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.15,75,,86.52,percent of total billed charges,75% of total billed charges for outpatient setting,119.69,83,,95.752,percent of total billed charges,83% of total billed charges for outpatient setting,72.1,50,,57.68,percent of total billed charges,50% of total billed charges for outpatient setting,72.1,50,,57.68,percent of total billed charges,50% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,119.69,
BODY FLUID GLUCOSE,1210345,CDM,300,RC,82945,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,68.89,
BODY FLUID CHLORIDE,1210350,CDM,300,RC,82438,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,29.05,
MAGNESIUM SERUM,1210351,CDM,300,RC,83735,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,19.09,
CSF CULTURE,1210352,CDM,300,RC,87070,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,149.4,
BODY FLUID PROTEIN,1210360,CDM,300,RC,84160,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,63.08,
ERYTHROPOIETIN,1210366,CDM,300,RC,82668,HCPCS,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,18.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.54,55.61,
VITAMIN A,1210369,CDM,300,RC,84590,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.31,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.21,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.21,34.86,
ELECTROLYTES,1210377,CDM,300,RC,80051,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,7.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.17,86.32,
FOLIC ACID,1210390,CDM,300,RC,82746,HCPCS,outpatient,,,44.73,22.37,,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.89,78,,27.912,percent of total billed charges,78% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,37.13,83,,29.704,percent of total billed charges,83% of total billed charges for outpatient setting,22.37,50,,17.896,percent of total billed charges,50% of total billed charges for outpatient setting,22.37,50,,17.896,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.94,37.13,
FAT STAIN QUAL,1210415,CDM,300,RC,82705,HCPCS,outpatient,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,63.91,
FIBRINOGEN TEST,1210420,CDM,300,RC,85384,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.48,34.03,
FTA=ABS,1210445,CDM,300,RC,86780,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.9,35,,43.12,percent of total billed charges,35% of total billed charges for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.32,39.17,,48.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,127.82,
STOOL PH,1210447,CDM,300,RC,83986,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,11.62,
GAMMA GT,1210450,CDM,300,RC,82977,HCPCS,outpatient,,,147,73.5,,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,7.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,110.25,75,,88.2,percent of total billed charges,75% of total billed charges for outpatient setting,110.25,75,,88.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,110.25,75,,88.2,percent of total billed charges,75% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,114.66,78,,91.728,percent of total billed charges,78% of total billed charges for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,102.9,70,,82.32,percent of total billed charges,70% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.25,75,,88.2,percent of total billed charges,75% of total billed charges for outpatient setting,122.01,83,,97.608,percent of total billed charges,83% of total billed charges for outpatient setting,73.5,50,,58.8,percent of total billed charges,50% of total billed charges for outpatient setting,73.5,50,,58.8,percent of total billed charges,50% of total billed charges for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,122.01,
G6PD,1210454,CDM,300,RC,82955,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,9.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.31,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.87,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.87,46.48,
GTT 2HR,1210455,CDM,300,RC,82951,HCPCS,outpatient,,,182,91,,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,141.96,78,,113.568,percent of total billed charges,78% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,127.4,70,,101.92,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,75,,109.2,percent of total billed charges,75% of total billed charges for outpatient setting,151.06,83,,120.848,percent of total billed charges,83% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,91,50,,72.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,151.06,
GRAM STAIN,1210476,CDM,300,RC,87205,HCPCS,outpatient,,,12.6,6.3,,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.83,78,,7.864,percent of total billed charges,78% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,10.46,83,,8.368,percent of total billed charges,83% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,10.46,
WET PREP,1210478,CDM,300,RC,87210,HCPCS,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,13.28,
HEMOGLOBIN ELECT,1210480,CDM,300,RC,83020,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.6,29.05,
HIAA-5,1210481,CDM,300,RC,83497,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.35,107.07,
IRON SERUM,1210485,CDM,300,RC,83540,HCPCS,outpatient,,,20.26,10.13,,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,15.8,78,,12.64,percent of total billed charges,78% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,16.82,83,,13.456,percent of total billed charges,83% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,16.82,
LDH,1210500,CDM,300,RC,83615,HCPCS,outpatient,,,24.48,12.24,,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.09,78,,15.272,percent of total billed charges,78% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,83,,16.256,percent of total billed charges,83% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,20.32,
LIPASE,1210515,CDM,300,RC,83690,HCPCS,outpatient,,,121.54,60.77,,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,91.16,75,,72.928,percent of total billed charges,75% of total billed charges for outpatient setting,91.16,75,,72.928,percent of total billed charges,75% of total billed charges for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,91.16,75,,72.928,percent of total billed charges,75% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,94.8,78,,75.84,percent of total billed charges,78% of total billed charges for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,85.08,70,,68.064,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.16,75,,72.928,percent of total billed charges,75% of total billed charges for outpatient setting,100.88,83,,80.704,percent of total billed charges,83% of total billed charges for outpatient setting,60.77,50,,48.616,percent of total billed charges,50% of total billed charges for outpatient setting,60.77,50,,48.616,percent of total billed charges,50% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100.88,
HLA-B27 AG,1210525,CDM,300,RC,86812,HCPCS,outpatient,,,256,128,,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,199.68,78,,159.744,percent of total billed charges,78% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,212.48,83,,169.984,percent of total billed charges,83% of total billed charges for outpatient setting,128,50,,102.4,percent of total billed charges,50% of total billed charges for outpatient setting,128,50,,102.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.72,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.72,212.48,
ALDOLASE,1210526,CDM,300,RC,82085,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.54,29.05,
CPK ISOENZYME,1210527,CDM,300,RC,82552,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.79,39.84,
THEOPHYLLINE,1210528,CDM,300,RC,80198,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.46,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.45,83,
VIT B 6-PYR PHOSP,1210529,CDM,300,RC,84207,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,28.1,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,28.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.73,83,
24HR CATECHOLAMINES URINE,1210530,CDM,300,RC,82384,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,74.7,
ANTI SMOOTH MUSCLE,1210540,CDM,300,RC,86256,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
FREE T4,1210545,CDM,300,RC,84439,HCPCS,outpatient,,,64.4,32.2,,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,9.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.23,78,,40.184,percent of total billed charges,78% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,53.45,83,,42.76,percent of total billed charges,83% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,53.45,
CALPROTECTON - STOOL,1210548,CDM,300,RC,83993,HCPCS,outpatient,,,541,270.5,,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,19.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,405.75,75,,324.6,percent of total billed charges,75% of total billed charges for outpatient setting,405.75,75,,324.6,percent of total billed charges,75% of total billed charges for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,405.75,75,,324.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,421.98,78,,337.584,percent of total billed charges,78% of total billed charges for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,378.7,70,,302.96,percent of total billed charges,70% of total billed charges for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,405.75,75,,324.6,percent of total billed charges,75% of total billed charges for outpatient setting,449.03,83,,359.224,percent of total billed charges,83% of total billed charges for outpatient setting,270.5,50,,216.4,percent of total billed charges,50% of total billed charges for outpatient setting,270.5,50,,216.4,percent of total billed charges,50% of total billed charges for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.28,449.03,
FREE T3,1210550,CDM,300,RC,84481,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,69.72,
LIPID PROFILE,1210556,CDM,300,RC,80061,HCPCS,outpatient,,,305.2,152.6,,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,75,,183.12,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,75,,183.12,percent of total billed charges,75% of total billed charges for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,75,,183.12,percent of total billed charges,75% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,238.06,78,,190.448,percent of total billed charges,78% of total billed charges for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,213.64,70,,170.912,percent of total billed charges,70% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228.9,75,,183.12,percent of total billed charges,75% of total billed charges for outpatient setting,253.32,83,,202.656,percent of total billed charges,83% of total billed charges for outpatient setting,152.6,50,,122.08,percent of total billed charges,50% of total billed charges for outpatient setting,152.6,50,,122.08,percent of total billed charges,50% of total billed charges for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.8,253.32,
VALPROIC ACID,1210565,CDM,300,RC,80164,HCPCS,outpatient,,,34.6,17.3,,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,25.95,75,,20.76,percent of total billed charges,75% of total billed charges for outpatient setting,25.95,75,,20.76,percent of total billed charges,75% of total billed charges for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,25.95,75,,20.76,percent of total billed charges,75% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.99,78,,21.592,percent of total billed charges,78% of total billed charges for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,24.22,70,,19.376,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.95,75,,20.76,percent of total billed charges,75% of total billed charges for outpatient setting,28.72,83,,22.976,percent of total billed charges,83% of total billed charges for outpatient setting,17.3,50,,13.84,percent of total billed charges,50% of total billed charges for outpatient setting,17.3,50,,13.84,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,28.72,
MALARIA & OTHER BLOOD PARASITE,1210570,CDM,300,RC,87207,HCPCS,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,18.26,
CEA,1210575,CDM,300,RC,82378,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,18.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,67.23,
MONO TEST,1210580,CDM,300,RC,86308,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,90.47,
O & P,1210585,CDM,300,RC,87177,HCPCS,outpatient,,,44.8,22.4,,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.9,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.94,78,,27.952,percent of total billed charges,78% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,37.18,83,,29.744,percent of total billed charges,83% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.83,37.18,
STOOL OCCULT BLOOD,1210595,CDM,300,RC,82272,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,12.45,
GASTRIN,1210615,CDM,300,RC,82941,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,17.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.53,52.29,
PHLEBOTOMY,1210630,CDM,940,RC,99195,HCPCS,outpatient,,,584,292,,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224.26,38.4,,179.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,204.4,35,,163.52,percent of total billed charges,35% of total billed charges for outpatient setting,455.52,78,,364.416,percent of total billed charges,78% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,408.8,70,,327.04,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,438,75,,350.4,percent of total billed charges,75% of total billed charges for outpatient setting,484.72,83,,387.776,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228.75,39.17,,183,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,484.72,
PHOSPHORUS,1210635,CDM,300,RC,84100,HCPCS,outpatient,,,15.19,7.6,,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,4.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.85,78,,9.48,percent of total billed charges,78% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,12.61,83,,10.088,percent of total billed charges,83% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.18,12.61,
PKU TEST,1210640,CDM,300,RC,84030,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,33.2,
POTASSIUM,1210655,CDM,300,RC,84132,HCPCS,outpatient,,,14.35,7.18,,10.05,70,,8.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.19,78,,8.952,percent of total billed charges,78% of total billed charges for outpatient setting,10.05,70,,8.04,percent of total billed charges,70% of total billed charges for outpatient setting,10.05,70,,8.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.76,75,,8.608,percent of total billed charges,75% of total billed charges for outpatient setting,11.91,83,,9.528,percent of total billed charges,83% of total billed charges for outpatient setting,7.18,50,,5.744,percent of total billed charges,50% of total billed charges for outpatient setting,7.18,50,,5.744,percent of total billed charges,50% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,11.91,
HCG QUALITATIVE,1210660,CDM,300,RC,84703,HCPCS,outpatient,,,187.6,93.8,,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,7.52,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,146.33,78,,117.064,percent of total billed charges,78% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,155.71,83,,124.568,percent of total billed charges,83% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,155.71,
PROTEIN ELECTROPHO,1210665,CDM,300,RC,84165,HCPCS,outpatient,,,32.92,16.46,,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.68,78,,20.544,percent of total billed charges,78% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,27.32,83,,21.856,percent of total billed charges,83% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,27.32,
PROTHROMBIN TIME,1210670,CDM,300,RC,85610,HCPCS,outpatient,,,12.66,6.33,,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.87,78,,7.896,percent of total billed charges,78% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,10.51,83,,8.408,percent of total billed charges,83% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,10.51,
POC TROPONIN,1210671,CDM,300,RC,84484,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.5,13,
POC CREATININE,1210672,CDM,300,RC,84484,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.5,13,
POC LACTIC ACID,1210673,CDM,300,RC,83605,HCPCS,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,11.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.4,32.37,
PTT,1210680,CDM,300,RC,85730,HCPCS,outpatient,,,18.57,9.29,,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.48,78,,11.584,percent of total billed charges,78% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.93,75,,11.144,percent of total billed charges,75% of total billed charges for outpatient setting,15.41,83,,12.328,percent of total billed charges,83% of total billed charges for outpatient setting,9.29,50,,7.432,percent of total billed charges,50% of total billed charges for outpatient setting,9.29,50,,7.432,percent of total billed charges,50% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,15.41,
RA TEST,1210685,CDM,300,RC,86430,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,110.39,
RETIC COUNT,1210690,CDM,300,RC,85044,HCPCS,outpatient,,,26.6,13.3,,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.75,78,,16.6,percent of total billed charges,78% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,83,,17.664,percent of total billed charges,83% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,22.08,
SALICYLATES SERUM,1210712,CDM,300,RC,80329,HCPCS,outpatient,,,89.46,44.73,,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.1,75,,53.68,percent of total billed charges,75% of total billed charges for outpatient setting,67.1,75,,53.68,percent of total billed charges,75% of total billed charges for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.1,75,,53.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.78,78,,55.824,percent of total billed charges,78% of total billed charges for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,62.62,70,,50.096,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.1,75,,53.68,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,83,,59.4,percent of total billed charges,83% of total billed charges for outpatient setting,44.73,50,,35.784,percent of total billed charges,50% of total billed charges for outpatient setting,44.73,50,,35.784,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.82,74.25,
SED RATE,1210715,CDM,300,RC,85651,HCPCS,outpatient,,,93.8,46.9,,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.46,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.46,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.16,78,,58.528,percent of total billed charges,78% of total billed charges for outpatient setting,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,65.66,70,,52.528,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.35,75,,56.28,percent of total billed charges,75% of total billed charges for outpatient setting,77.85,83,,62.28,percent of total billed charges,83% of total billed charges for outpatient setting,46.9,50,,37.52,percent of total billed charges,50% of total billed charges for outpatient setting,46.9,50,,37.52,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.12,77.85,
ACETONE QUAL,1210718,CDM,300,RC,82009,HCPCS,outpatient,,,42.2,21.1,,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,4.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.92,78,,26.336,percent of total billed charges,78% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,29.54,70,,23.632,percent of total billed charges,70% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.65,75,,25.32,percent of total billed charges,75% of total billed charges for outpatient setting,35.03,83,,28.024,percent of total billed charges,83% of total billed charges for outpatient setting,21.1,50,,16.88,percent of total billed charges,50% of total billed charges for outpatient setting,21.1,50,,16.88,percent of total billed charges,50% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.89,35.03,
DILANTIN,1210719,CDM,300,RC,80185,HCPCS,outpatient,,,55.7,27.85,,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.45,78,,34.76,percent of total billed charges,78% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,46.23,83,,36.984,percent of total billed charges,83% of total billed charges for outpatient setting,27.85,50,,22.28,percent of total billed charges,50% of total billed charges for outpatient setting,27.85,50,,22.28,percent of total billed charges,50% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,46.23,
SGOT/AST,1210720,CDM,300,RC,84450,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,15.77,
SGPT/ALT,1210725,CDM,300,RC,84460,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,15.77,
SICKLEDEX TEST,1210730,CDM,300,RC,85660,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,68.89,
SODIUM,1210740,CDM,300,RC,84295,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,4.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.35,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,83,
SPERM COUNT,1210742,CDM,300,RC,89310,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.63,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,50.63,
STONES ANALYSIS,1210758,CDM,300,RC,82355,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,11.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.19,66.4,
CARBON MONOXIDE,1210760,CDM,300,RC,82375,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,12.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.53,17.43,
PHENOBARB LEVEL,1210770,CDM,300,RC,80184,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.09,48.14,
SUGAR & ACETONE URINE,1210775,CDM,300,RC,81002,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,3.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,14.94,
IGM,1210785,CDM,300,RC,82784,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,27.39,
T3 UPTAKE,1210790,CDM,300,RC,84479,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,74.7,
T4,1210795,CDM,300,RC,84436,HCPCS,outpatient,,,24.48,12.24,,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,6.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.08,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.09,78,,15.272,percent of total billed charges,78% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,83,,16.256,percent of total billed charges,83% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,20.32,
ALPHA-1-ANTITRYPSIN,1210800,CDM,300,RC,82103,HCPCS,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.73,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,55.61,
ANTI-DNA-AB DS,1210803,CDM,300,RC,86225,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.1,40.67,
ARSENIC,1210805,CDM,300,RC,82175,HCPCS,outpatient,,,134,67,,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,104.52,78,,83.616,percent of total billed charges,78% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.22,83,,88.976,percent of total billed charges,83% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,111.22,
COMPLEMENT C4,1210825,CDM,300,RC,86160,HCPCS,outpatient,,,61.6,30.8,,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,48.05,78,,38.44,percent of total billed charges,78% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,51.13,83,,40.904,percent of total billed charges,83% of total billed charges for outpatient setting,30.8,50,,24.64,percent of total billed charges,50% of total billed charges for outpatient setting,30.8,50,,24.64,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,51.13,
FSH,1210830,CDM,300,RC,83001,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.54,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.36,109.56,
24HR PROTEIN URINE,1210840,CDM,300,RC,84160,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,15.77,
24HR CREATININE URINE,1210845,CDM,300,RC,83491,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.41,62.25,
OSMOLALITY SERUM,1210852,CDM,300,RC,83930,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,6.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,23.24,
IGA,1210853,CDM,300,RC,82784,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,54.78,
TOTAL PROTEIN,1210855,CDM,300,RC,84155,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,21.58,
IGE,1210860,CDM,300,RC,82785,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.5,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.5,48.97,
TRIGLYCERIDES,1210865,CDM,300,RC,84478,HCPCS,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,5.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,24.07,
GLUCOSE 2 HR POST PRANDIAL,1210870,CDM,300,RC,82947,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,39.84,
CREATININE CLEARANCE,1210880,CDM,300,RC,82575,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,9.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.32,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.32,28.22,
URINE SODIUM,1210891,CDM,300,RC,84300,HCPCS,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,10.79,
"URINE, POTASSIUM",1210892,CDM,300,RC,84133,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,12.45,
URIC ACID,1210900,CDM,300,RC,84550,HCPCS,outpatient,,,23.8,11.9,,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,4.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.56,78,,14.848,percent of total billed charges,78% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,19.75,83,,15.8,percent of total billed charges,83% of total billed charges for outpatient setting,11.9,50,,9.52,percent of total billed charges,50% of total billed charges for outpatient setting,11.9,50,,9.52,percent of total billed charges,50% of total billed charges for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.98,19.75,
RPR ROUTINE,1210910,CDM,300,RC,86592,HCPCS,outpatient,,,22.4,11.2,,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,75,,13.44,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,75,,13.44,percent of total billed charges,75% of total billed charges for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,75,,13.44,percent of total billed charges,75% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.47,78,,13.976,percent of total billed charges,78% of total billed charges for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,15.68,70,,12.544,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,75,,13.44,percent of total billed charges,75% of total billed charges for outpatient setting,18.59,83,,14.872,percent of total billed charges,83% of total billed charges for outpatient setting,11.2,50,,8.96,percent of total billed charges,50% of total billed charges for outpatient setting,11.2,50,,8.96,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.26,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.26,18.59,
VMA,1210920,CDM,300,RC,84585,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,46.48,
HEPATITIS C ANTIB,1210925,CDM,300,RC,86803,HCPCS,outpatient,,,71.4,35.7,,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,14.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,55.69,78,,44.552,percent of total billed charges,78% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,59.26,83,,47.408,percent of total billed charges,83% of total billed charges for outpatient setting,35.7,50,,28.56,percent of total billed charges,50% of total billed charges for outpatient setting,35.7,50,,28.56,percent of total billed charges,50% of total billed charges for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,59.26,
IMIPRAMINE,1210927,CDM,300,RC,80335,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,61,50,,48.8,percent of total billed charges,50% of total billed charges for outpatient setting,61,50,,48.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,101.26,
VANCOMYCIN RANDOM,1210928,CDM,300,RC,80202,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.99,34.03,
24HR URINE ALDOSTERONE,1220015,CDM,300,RC,82088,HCPCS,outpatient,,,289,144.5,,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,216.75,75,,173.4,percent of total billed charges,75% of total billed charges for outpatient setting,216.75,75,,173.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,216.75,75,,173.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,225.42,78,,180.336,percent of total billed charges,78% of total billed charges for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,202.3,70,,161.84,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216.75,75,,173.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.87,83,,191.896,percent of total billed charges,83% of total billed charges for outpatient setting,144.5,50,,115.6,percent of total billed charges,50% of total billed charges for outpatient setting,144.5,50,,115.6,percent of total billed charges,50% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,239.87,
CALCITONIN,1220017,CDM,300,RC,82308,HCPCS,outpatient,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,26.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,33.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.35,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.57,157.7,
FREE PLASMA HGB,1220019,CDM,300,RC,83051,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.31,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,43.16,
ALDOSTERONE,1220021,CDM,300,RC,82088,HCPCS,outpatient,,,145,72.5,,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,113.1,78,,90.48,percent of total billed charges,78% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,120.35,83,,96.28,percent of total billed charges,83% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,120.35,
GLYCOHEMOGLOBIN,1220023,CDM,300,RC,83036,HCPCS,outpatient,,,29.54,14.77,,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,9.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.04,78,,18.432,percent of total billed charges,78% of total billed charges for outpatient setting,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,20.68,70,,16.544,percent of total billed charges,70% of total billed charges for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,75,,17.728,percent of total billed charges,75% of total billed charges for outpatient setting,24.52,83,,19.616,percent of total billed charges,83% of total billed charges for outpatient setting,14.77,50,,11.816,percent of total billed charges,50% of total billed charges for outpatient setting,14.77,50,,11.816,percent of total billed charges,50% of total billed charges for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.54,24.52,
FIBRIN SPLIT PRODUCT,1220024,CDM,300,RC,85362,HCPCS,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,20.75,
ROTAVIRUS ANTIGEN,1220026,CDM,300,RC,86759,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,18.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,39.84,
CA 125,1220031,CDM,300,RC,86304,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,62.25,
PROGESTERONE LEVEL,1220033,CDM,300,RC,84144,HCPCS,outpatient,,,235,117.5,,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,20.86,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,25.76,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.89,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,183.3,78,,146.64,percent of total billed charges,78% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,195.05,83,,156.04,percent of total billed charges,83% of total billed charges for outpatient setting,117.5,50,,94,percent of total billed charges,50% of total billed charges for outpatient setting,117.5,50,,94,percent of total billed charges,50% of total billed charges for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,195.05,
CLOSTRIDIUM DIFFICLE TOXIN,1220034,CDM,300,RC,87230,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,19.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.38,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.38,98.77,
COLD AGGLUTININS,1220035,CDM,300,RC,86157,HCPCS,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,8.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.1,47.31,
RESP SYNTICAL VIRUS,1220036,CDM,300,RC,86756,HCPCS,outpatient,,,39.67,19.84,,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,15.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.94,78,,24.752,percent of total billed charges,78% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.93,83,,26.344,percent of total billed charges,83% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.35,32.93,
VARICELLA TITER,1220039,CDM,300,RC,86787,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,39.01,
URINE IMMUNOFIXATION,1220042,CDM,300,RC,86325,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,23.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.53,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,23.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.68,66.4,
IONIZED CA,1220045,CDM,300,RC,82330,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.03,40.67,
LYME,1220046,CDM,300,RC,86618,HCPCS,outpatient,,,303,151.5,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,17.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,236.34,78,,189.072,percent of total billed charges,78% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,251.49,83,,201.192,percent of total billed charges,83% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,251.49,
ESTRADIOL,1220047,CDM,300,RC,82670,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,27.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.6,234.06,
LIDOCAINE LEVEL,1220048,CDM,300,RC,80176,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.93,86.32,
INSULIN ANTIBODY,1220050,CDM,300,RC,86337,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,21.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.85,126.16,
CRYSTAL ANALYSIS,1220052,CDM,300,RC,89060,HCPCS,outpatient,,,144,72,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.33,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,112.32,78,,89.856,percent of total billed charges,78% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.52,83,,95.616,percent of total billed charges,83% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.29,119.52,
ANTI PLATELET ANTIBO,1220054,CDM,300,RC,86022,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.16,53.95,
LUTEINIZING HORMONE,1220095,CDM,300,RC,83002,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,18.52,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.45,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,54.78,
TRANSFERRIN,1220395,CDM,300,RC,84466,HCPCS,outpatient,,,38.82,19.41,,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,12.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.28,78,,24.224,percent of total billed charges,78% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,70,,21.736,percent of total billed charges,70% of total billed charges for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.12,75,,23.296,percent of total billed charges,75% of total billed charges for outpatient setting,32.22,83,,25.776,percent of total billed charges,83% of total billed charges for outpatient setting,19.41,50,,15.528,percent of total billed charges,50% of total billed charges for outpatient setting,19.41,50,,15.528,percent of total billed charges,50% of total billed charges for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.24,32.22,
QUINIDINE LEVEL,1220595,CDM,300,RC,80194,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.85,85.49,
COPPER,1222017,CDM,300,RC,82525,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.93,37.35,
CERULOPLASIM,1222018,CDM,300,RC,82390,HCPCS,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,132.8,
MITOCHONDRIAL M2 AB,1222019,CDM,300,RC,83516,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,131.14,
FERRITIN LEVEL,1222020,CDM,300,RC,82728,HCPCS,outpatient,,,41.36,20.68,,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,13.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.26,78,,25.808,percent of total billed charges,78% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,34.33,83,,27.464,percent of total billed charges,83% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.99,34.33,
PROCAINAMIDE LEVEL,1222021,CDM,300,RC,80192,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.75,98.77,
COD RAST,1222022,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
BASS RAST,1222023,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
PERCH RAST,1222024,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
TILAPIA RAST,1222025,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
MANGANESE,1224560,CDM,300,RC,83785,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,26.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,30.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.64,140.27,
DIGOXIN SERUM,1230105,CDM,300,RC,80162,HCPCS,outpatient,,,67.2,33.6,,47.04,70,,37.632,percent of total billed charges,70% of total billed charges for outpatient setting,13.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.54,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.42,78,,41.936,percent of total billed charges,78% of total billed charges for outpatient setting,47.04,70,,37.632,percent of total billed charges,70% of total billed charges for outpatient setting,47.04,70,,37.632,percent of total billed charges,70% of total billed charges for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,75,,40.32,percent of total billed charges,75% of total billed charges for outpatient setting,55.78,83,,44.624,percent of total billed charges,83% of total billed charges for outpatient setting,33.6,50,,26.88,percent of total billed charges,50% of total billed charges for outpatient setting,33.6,50,,26.88,percent of total billed charges,50% of total billed charges for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.69,55.78,
TCELL CLONALITY PANEL (B),1232556,CDM,300,RC,84999,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,85.49,
IMMUNOFIXATION SERUM,1240002,CDM,300,RC,86334,HCPCS,outpatient,,,67.52,33.76,,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,22.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,50.64,75,,40.512,percent of total billed charges,75% of total billed charges for outpatient setting,50.64,75,,40.512,percent of total billed charges,75% of total billed charges for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,50.64,75,,40.512,percent of total billed charges,75% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.67,78,,42.136,percent of total billed charges,78% of total billed charges for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,47.26,70,,37.808,percent of total billed charges,70% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.64,75,,40.512,percent of total billed charges,75% of total billed charges for outpatient setting,56.04,83,,44.832,percent of total billed charges,83% of total billed charges for outpatient setting,33.76,50,,27.008,percent of total billed charges,50% of total billed charges for outpatient setting,33.76,50,,27.008,percent of total billed charges,50% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.66,56.04,
LITHIUM,1240004,CDM,300,RC,80178,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,27.39,
RENIN,1240005,CDM,300,RC,84244,HCPCS,outpatient,,,216,108,,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,168.48,78,,134.784,percent of total billed charges,78% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.28,83,,143.424,percent of total billed charges,83% of total billed charges for outpatient setting,108,50,,86.4,percent of total billed charges,50% of total billed charges for outpatient setting,108,50,,86.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.36,179.28,
PORPHYRINS SERUM,1240007,CDM,300,RC,84311,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,8.1,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.15,41.5,
17 KETOSTEROIDS,1240008,CDM,300,RC,83586,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.06,73.87,
PINWORM EXAM,1240010,CDM,300,RC,87172,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,24.9,
TRYPSIN,1240011,CDM,300,RC,84490,HCPCS,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,9.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,44.82,
FUNGUS SMEAR W FLUORESCENT KOH,1240013,CDM,300,RC,87206,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,15.77,
AMIKACIN PEAK,1243703,CDM,300,RC,80150,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,89.64,
AMIKACIN TROUGH,1243704,CDM,300,RC,80150,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,89.64,
TOBRAMYCIN TROUGH,1243705,CDM,300,RC,80200,HCPCS,outpatient,,,215,107.5,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,16.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.84,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,19.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.78,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,167.7,78,,134.16,percent of total billed charges,78% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,178.45,83,,142.76,percent of total billed charges,83% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,178.45,
NORTRIPTYLINE,1243706,CDM,300,RC,80335,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,67.23,
BODY FLUID CELL CT,1246853,CDM,300,RC,89050,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.17,19.92,
CSF GRAM STAIN,1246854,CDM,300,RC,87205,HCPCS,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,38.18,
CSF INDIA INK,1246855,CDM,300,RC,87210,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,73.87,
ACETAMINOPHEN,1255511,CDM,300,RC,80329,HCPCS,outpatient,,,207.62,103.81,,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,155.72,75,,124.576,percent of total billed charges,75% of total billed charges for outpatient setting,155.72,75,,124.576,percent of total billed charges,75% of total billed charges for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,155.72,75,,124.576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,161.94,78,,129.552,percent of total billed charges,78% of total billed charges for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,145.33,70,,116.264,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.72,75,,124.576,percent of total billed charges,75% of total billed charges for outpatient setting,172.32,83,,137.856,percent of total billed charges,83% of total billed charges for outpatient setting,103.81,50,,83.048,percent of total billed charges,50% of total billed charges for outpatient setting,103.81,50,,83.048,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.82,172.32,
REVERSE T3,1255555,CDM,300,RC,84482,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.87,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.87,92.96,
THY MICROSOMAL AB,1255559,CDM,300,RC,86376,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,85.49,
CLOTEST,1260003,CDM,300,RC,87077,HCPCS,outpatient,,,176.4,88.2,,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,132.3,75,,105.84,percent of total billed charges,75% of total billed charges for outpatient setting,132.3,75,,105.84,percent of total billed charges,75% of total billed charges for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,132.3,75,,105.84,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,137.59,78,,110.072,percent of total billed charges,78% of total billed charges for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,123.48,70,,98.784,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.3,75,,105.84,percent of total billed charges,75% of total billed charges for outpatient setting,146.41,83,,117.128,percent of total billed charges,83% of total billed charges for outpatient setting,88.2,50,,70.56,percent of total billed charges,50% of total billed charges for outpatient setting,88.2,50,,70.56,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,146.41,
YEAST ID,1260007,CDM,300,RC,87106,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,61.42,
ID ADDITIONAL ORGANI,1260008,CDM,300,RC,87077,HCPCS,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,24.07,
ANA TITER,1260321,CDM,300,RC,86039,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,11.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.83,92.96,
H PYLORI IGM AB,1260324,CDM,300,RC,86677,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,85.49,
HEPATITIS PANEL,1260331,CDM,300,RC,80074,HCPCS,outpatient,,,236.6,118.3,,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,47.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,177.45,75,,141.96,percent of total billed charges,75% of total billed charges for outpatient setting,177.45,75,,141.96,percent of total billed charges,75% of total billed charges for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,177.45,75,,141.96,percent of total billed charges,75% of total billed charges for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,184.55,78,,147.64,percent of total billed charges,78% of total billed charges for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,165.62,70,,132.496,percent of total billed charges,70% of total billed charges for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177.45,75,,141.96,percent of total billed charges,75% of total billed charges for outpatient setting,196.38,83,,157.104,percent of total billed charges,83% of total billed charges for outpatient setting,118.3,50,,94.64,percent of total billed charges,50% of total billed charges for outpatient setting,118.3,50,,94.64,percent of total billed charges,50% of total billed charges for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,47.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.92,196.38,
HEP B SURFACE AG,1260337,CDM,300,RC,87340,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,10.33,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,127.82,
H PYLORI IGG AB,1260341,CDM,300,RC,86677,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,85.49,
PLATELET COUNT MANUAL,1260503,CDM,300,RC,85032,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,52.29,
STREP SCREEN,1260505,CDM,300,RC,87880,HCPCS,outpatient,,,36.29,18.15,,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.31,78,,22.648,percent of total billed charges,78% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,30.12,83,,24.096,percent of total billed charges,83% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,30.12,
COVID 19 PCR,1270505,CDM,300,RC,87635,HCPCS,outpatient,,,215.6,107.8,,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,51.31,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,75,,129.36,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,75,,129.36,percent of total billed charges,75% of total billed charges for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,75,,129.36,percent of total billed charges,75% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,168.17,78,,134.536,percent of total billed charges,78% of total billed charges for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,150.92,70,,120.736,percent of total billed charges,70% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161.7,75,,129.36,percent of total billed charges,75% of total billed charges for outpatient setting,178.95,83,,143.16,percent of total billed charges,83% of total billed charges for outpatient setting,107.8,50,,86.24,percent of total billed charges,50% of total billed charges for outpatient setting,107.8,50,,86.24,percent of total billed charges,50% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,178.95,
DPH COVID 19 PCR,1270507,CDM,300,RC,87635,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,51.31,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,51.31,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.92,66.4,
TOXOPLASMA IGG,1270514,CDM,300,RC,86777,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
LEGIONELLA URINE,1270519,CDM,300,RC,86713,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.48,90.47,
AMIODARONE,1270523,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
RMSF IGG,1270526,CDM,300,RC,86757,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,113.71,
NICOTINE & COTININE METABOLITE,1270528,CDM,300,RC,80323,HCPCS,outpatient,,,168,84,,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,126,75,,100.8,percent of total billed charges,75% of total billed charges for outpatient setting,126,75,,100.8,percent of total billed charges,75% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,126,75,,100.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,131.04,78,,104.832,percent of total billed charges,78% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126,75,,100.8,percent of total billed charges,75% of total billed charges for outpatient setting,139.44,83,,111.552,percent of total billed charges,83% of total billed charges for outpatient setting,84,50,,67.2,percent of total billed charges,50% of total billed charges for outpatient setting,84,50,,67.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.43,139.44,
ANTI PARIETAL CELL A,1270529,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
INTRINSIC FACTOR BLOCKING AB,1270530,CDM,300,RC,86340,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,89.64,
NEURONTIN LEVEL,1270531,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
OXALATE,1270541,CDM,300,RC,83945,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,75.53,
HYDROXY PROGESTERONE,1270542,CDM,300,RC,83498,HCPCS,outpatient,,,193,96.5,,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.87,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,150.54,78,,120.432,percent of total billed charges,78% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,160.19,83,,128.152,percent of total billed charges,83% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.91,160.19,
CARNITINE,1270543,CDM,300,RC,82379,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
BETA 2 MICROGOBULIN,1270550,CDM,300,RC,82232,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,48.14,
HIV CONF WESTERN BLO,1270552,CDM,300,RC,86689,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,113.71,
PRE ALBUMIN TEST,1270558,CDM,300,RC,84134,HCPCS,outpatient,,,43.89,21.95,,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,14.59,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,32.92,75,,26.336,percent of total billed charges,75% of total billed charges for outpatient setting,32.92,75,,26.336,percent of total billed charges,75% of total billed charges for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,32.92,75,,26.336,percent of total billed charges,75% of total billed charges for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.23,78,,27.384,percent of total billed charges,78% of total billed charges for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,30.72,70,,24.576,percent of total billed charges,70% of total billed charges for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.92,75,,26.336,percent of total billed charges,75% of total billed charges for outpatient setting,36.43,83,,29.144,percent of total billed charges,83% of total billed charges for outpatient setting,21.95,50,,17.56,percent of total billed charges,50% of total billed charges for outpatient setting,21.95,50,,17.56,percent of total billed charges,50% of total billed charges for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.84,36.43,
ANGIOTENSION COV ENZ,1270562,CDM,300,RC,82164,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.85,43.16,
DOXEPIN,1270565,CDM,300,RC,80335,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,92.13,
CMV IGG,1270566,CDM,300,RC,86644,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
CYCLOSPORIN,1270575,CDM,300,RC,80158,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,18.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.25,35.69,
MYOGLOBIN URINE,1270578,CDM,300,RC,83874,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,76.36,
MYCOPLASMA IGM,1270585,CDM,300,RC,86738,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,78.02,
FRUCTOSAMINE TEST,1270595,CDM,300,RC,82985,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.27,89.64,
ANTIMICROSOMAL ANTIB,1270596,CDM,300,RC,86376,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,85.49,
RMSF IGM,1270598,CDM,300,RC,86757,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,113.71,
IGF-1 (SOMATONEDIN-C),1270601,CDM,300,RC,84305,HCPCS,outpatient,,,151,75.5,,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,21.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,113.25,75,,90.6,percent of total billed charges,75% of total billed charges for outpatient setting,113.25,75,,90.6,percent of total billed charges,75% of total billed charges for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,113.25,75,,90.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,117.78,78,,94.224,percent of total billed charges,78% of total billed charges for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,105.7,70,,84.56,percent of total billed charges,70% of total billed charges for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.25,75,,90.6,percent of total billed charges,75% of total billed charges for outpatient setting,125.33,83,,100.264,percent of total billed charges,83% of total billed charges for outpatient setting,75.5,50,,60.4,percent of total billed charges,50% of total billed charges for outpatient setting,75.5,50,,60.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.71,125.33,
DHEA,1270602,CDM,300,RC,82626,HCPCS,outpatient,,,312,156,,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,243.36,78,,194.688,percent of total billed charges,78% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,258.96,83,,207.168,percent of total billed charges,83% of total billed charges for outpatient setting,156,50,,124.8,percent of total billed charges,50% of total billed charges for outpatient setting,156,50,,124.8,percent of total billed charges,50% of total billed charges for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,258.96,
RNP ANTIBODY,1270603,CDM,300,RC,86235,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,105.41,
SCL70,1270604,CDM,300,RC,86235,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,73.87,
ANTI CENTROMERE AB,1270605,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
CSF CRYPTOCOCCAL AG,1270607,CDM,300,RC,86641,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,14.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.69,19.04,
L/S RATIO,1270611,CDM,300,RC,83661,HCPCS,outpatient,,,156,78,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.64,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.64,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,121.68,78,,97.344,percent of total billed charges,78% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,83,,103.584,percent of total billed charges,83% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,129.48,
C-PEPTIDE,1270614,CDM,300,RC,84681,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.99,66.4,
SPERM COUNT POST VAS,1270615,CDM,300,RC,89321,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,34.86,
CPK TOTAL,1270622,CDM,300,RC,82550,HCPCS,outpatient,,,33.6,16.8,,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,6.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,75,,20.16,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,75,,20.16,percent of total billed charges,75% of total billed charges for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,75,,20.16,percent of total billed charges,75% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.21,78,,20.968,percent of total billed charges,78% of total billed charges for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,23.52,70,,18.816,percent of total billed charges,70% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,75,,20.16,percent of total billed charges,75% of total billed charges for outpatient setting,27.89,83,,22.312,percent of total billed charges,83% of total billed charges for outpatient setting,16.8,50,,13.44,percent of total billed charges,50% of total billed charges for outpatient setting,16.8,50,,13.44,percent of total billed charges,50% of total billed charges for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,27.89,
LEUCOPOR FILTER RBC,1270627,CDM,272,RC,,,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
TOXOCARA IGA,1270629,CDM,300,RC,86317,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,71.38,
RAST - EACH ALLERGEN,1270631,CDM,300,RC,86003,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,43.99,
RAST EA DRUG ALLERGE,1270633,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
SAP 10 DRUG SCREEN,1270634,CDM,300,RC,80307,HCPCS,outpatient,,,219.44,109.72,,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,164.58,75,,131.664,percent of total billed charges,75% of total billed charges for outpatient setting,164.58,75,,131.664,percent of total billed charges,75% of total billed charges for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,164.58,75,,131.664,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,171.16,78,,136.928,percent of total billed charges,78% of total billed charges for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,153.61,70,,122.888,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.58,75,,131.664,percent of total billed charges,75% of total billed charges for outpatient setting,182.14,83,,145.712,percent of total billed charges,83% of total billed charges for outpatient setting,109.72,50,,87.776,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,50,,87.776,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,182.14,
DRUG CONFIRM-EA DRUG,1270636,CDM,300,RC,80301,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
SAP 6 DRUG SCREEN,1270637,CDM,300,RC,80307,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,165.17,
BUTTERFLY,1270638,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
TENDERFOOT,1270639,CDM,272,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
CMV IGM,1270640,CDM,300,RC,86645,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,99.6,
PTH - INTACT,1270641,CDM,300,RC,83970,HCPCS,outpatient,,,124.07,62.04,,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.05,75,,74.44,percent of total billed charges,75% of total billed charges for outpatient setting,93.05,75,,74.44,percent of total billed charges,75% of total billed charges for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.05,75,,74.44,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,96.77,78,,77.416,percent of total billed charges,78% of total billed charges for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,86.85,70,,69.48,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.05,75,,74.44,percent of total billed charges,75% of total billed charges for outpatient setting,102.98,83,,82.384,percent of total billed charges,83% of total billed charges for outpatient setting,62.04,50,,49.632,percent of total billed charges,50% of total billed charges for outpatient setting,62.04,50,,49.632,percent of total billed charges,50% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,102.98,
PARVO IGG-EIA OR IFA,1270643,CDM,300,RC,86747,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.85,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,87.98,
PARVO IGM-EIA OR IFA,1270644,CDM,300,RC,86747,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.85,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,87.98,
CA 15-3,1270650,CDM,300,RC,86300,HCPCS,outpatient,,,148,74,,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,115.44,78,,92.352,percent of total billed charges,78% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.84,83,,98.272,percent of total billed charges,83% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,122.84,
FACTOR 8,1270655,CDM,300,RC,85240,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,105.41,
FACTOR 9 ACT CLOTTING,1270656,CDM,300,RC,85250,HCPCS,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,19.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.76,112.05,
HISTONE AB,1270658,CDM,300,RC,86235,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,105.41,
LACTIC ACID,1270659,CDM,300,RC,83605,HCPCS,outpatient,,,32.92,16.46,,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,11.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.68,78,,20.544,percent of total billed charges,78% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,27.32,83,,21.856,percent of total billed charges,83% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.4,27.32,
SUDAN BLACK B STAIN,1270661,CDM,300,RC,82705,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,30.71,
URINE 24HR PORPHYRIN,1270662,CDM,300,RC,84120,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,86.32,
VON WILLEBRAND FACTOR ACTIVITY,1270665,CDM,300,RC,85245,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,135.29,
FACTOR 7,1270667,CDM,300,RC,85230,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,105.41,
FACTOR 12-HAGEMAN,1270668,CDM,300,RC,85280,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.04,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.04,113.71,
FACTOR II,1270669,CDM,300,RC,85210,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.43,76.36,
GLUCOSE ADDITIONAL,1270670,CDM,300,RC,82950,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,27.39,
"BB ADM-PC,FFP,PLT,CRYO",1270673,CDM,391,RC,36430,HCPCS,outpatient,,,1027.6,513.8,,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,394.6,38.4,,315.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,394.6,38.4,,315.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,770.7,75,,616.56,percent of total billed charges,75% of total billed charges for outpatient setting,770.7,75,,616.56,percent of total billed charges,75% of total billed charges for outpatient setting,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,770.7,75,,616.56,percent of total billed charges,75% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,359.66,35,,287.728,percent of total billed charges,35% of total billed charges for outpatient setting,801.53,78,,641.224,percent of total billed charges,78% of total billed charges for outpatient setting,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,719.32,70,,575.456,percent of total billed charges,70% of total billed charges for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,770.7,75,,616.56,percent of total billed charges,75% of total billed charges for outpatient setting,852.91,83,,682.328,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,402.49,39.17,,321.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,372.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,359.66,852.91,
CA 19-9,1270678,CDM,300,RC,86301,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,62.25,
ACETHYLCHOL RECEP BINDING AB,1270680,CDM,300,RC,83519,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,79.68,
FECAL LEUCOCYTES,1270685,CDM,300,RC,89055,HCPCS,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,9.13,
CBC DIFF/PED,1270686,CDM,300,RC,85025,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,26.56,
SKELETAL MUSCLE AB,1270688,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
OPIATES - SERUM,1270692,CDM,300,RC,80301,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
STREPTOZYME TITER,1270698,CDM,300,RC,86063,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.62,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,34.86,
DIRECT BILIRUBIN,1270702,CDM,300,RC,82248,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,5.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.19,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,87.98,
HEP C BY RIBA 2,1270704,CDM,300,RC,86317,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,71.38,
AMITRYPTYLINE LEVEL,1270705,CDM,300,RC,80335,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.76,105.41,
GALACTOSEMIA-PLASMA,1270709,CDM,300,RC,82776,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.38,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.38,49.8,
REDUCING SUBSTANCE,1270710,CDM,300,RC,84999,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
AMPH GC/MS URINE,1270715,CDM,300,RC,80324,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.53,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.69,92.13,
INFLUENZA A&B-IGM,1270717,CDM,300,RC,86710,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.94,40.67,
MICROALBUMIN URINE,1270719,CDM,300,RC,82043,HCPCS,outpatient,,,29.4,14.7,,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,22.93,78,,18.344,percent of total billed charges,78% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,24.4,83,,19.52,percent of total billed charges,83% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.1,24.4,
GROWTH HORMONE,1270720,CDM,300,RC,83003,HCPCS,outpatient,,,101,50.5,,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,16.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78.78,78,,63.024,percent of total billed charges,78% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.83,83,,67.064,percent of total billed charges,83% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.53,83.83,
CHOLESTEROL VLDL,1270721,CDM,300,RC,83719,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
VENI - UNDER 3 YO,1270730,CDM,300,RC,36406,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
ORGANIC ACIDS-URINE,1270731,CDM,300,RC,83918,HCPCS,outpatient,,,117,58.5,,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,23.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,91.26,78,,73.008,percent of total billed charges,78% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,97.11,83,,77.688,percent of total billed charges,83% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,23.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,97.11,
CRYPTOCOCCUS ANTIGEN,1270734,CDM,300,RC,87449,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,49.8,
24HR URINE COPPER,1270737,CDM,300,RC,82525,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.93,73.04,
OLIGOCLONAL BANDS,1270739,CDM,300,RC,83916,HCPCS,outpatient,,,142,71,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,27.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.54,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,110.76,78,,88.608,percent of total billed charges,78% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.86,83,,94.288,percent of total billed charges,83% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.7,117.86,
HEEL WARMER,1270741,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
HEMOSIDERIN STAIN,1270743,CDM,300,RC,83070,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
LAMICTAL,1270747,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
BB ANTIBODY TITER,1270753,CDM,300,RC,86886,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,146.71,
ADENOVIRUS AB,1270755,CDM,300,RC,86603,HCPCS,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,38.18,
HEMOGLOBIN,1270757,CDM,300,RC,85018,HCPCS,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,6.31,
HEMATOCRIT,1270759,CDM,300,RC,85014,HCPCS,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.93,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.09,6.31,
CKMB,1270760,CDM,300,RC,82553,HCPCS,outpatient,,,35.45,17.73,,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.65,78,,22.12,percent of total billed charges,78% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,29.42,83,,23.536,percent of total billed charges,83% of total billed charges for outpatient setting,17.73,50,,14.184,percent of total billed charges,50% of total billed charges for outpatient setting,17.73,50,,14.184,percent of total billed charges,50% of total billed charges for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,29.42,
EOSINOPHIL URINE,1270761,CDM,300,RC,89190,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
KOH PREP,1270763,CDM,300,RC,87210,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,73.87,
TROPONIN - I,1270765,CDM,300,RC,84484,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,28.22,
THROAT CULTURE,1270768,CDM,300,RC,87070,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,50.63,
N&P CULTURE,1270769,CDM,300,RC,87070,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,106.24,
AEROBE CULTURE,1270770,CDM,300,RC,87070,HCPCS,outpatient,,,25.32,12.66,,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,18.99,75,,15.192,percent of total billed charges,75% of total billed charges for outpatient setting,18.99,75,,15.192,percent of total billed charges,75% of total billed charges for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,18.99,75,,15.192,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.75,78,,15.8,percent of total billed charges,78% of total billed charges for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,70,,14.176,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.99,75,,15.192,percent of total billed charges,75% of total billed charges for outpatient setting,21.02,83,,16.816,percent of total billed charges,83% of total billed charges for outpatient setting,12.66,50,,10.128,percent of total billed charges,50% of total billed charges for outpatient setting,12.66,50,,10.128,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,21.02,
ANAEROBE CULTURE,1270771,CDM,300,RC,87075,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,9.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.33,113.71,
BLOOD CULTURE,1270772,CDM,300,RC,87040,HCPCS,outpatient,,,30.38,15.19,,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,22.79,75,,18.232,percent of total billed charges,75% of total billed charges for outpatient setting,22.79,75,,18.232,percent of total billed charges,75% of total billed charges for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,22.79,75,,18.232,percent of total billed charges,75% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.7,78,,18.96,percent of total billed charges,78% of total billed charges for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,21.27,70,,17.016,percent of total billed charges,70% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.79,75,,18.232,percent of total billed charges,75% of total billed charges for outpatient setting,25.22,83,,20.176,percent of total billed charges,83% of total billed charges for outpatient setting,15.19,50,,12.152,percent of total billed charges,50% of total billed charges for outpatient setting,15.19,50,,12.152,percent of total billed charges,50% of total billed charges for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,25.22,
CERVICAL CULTURE,1270773,CDM,300,RC,87070,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,149.4,
URETHRAL CULTURE,1270774,CDM,300,RC,87070,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,50.63,
STOOL CULT FOR SAL & SHIG,1270775,CDM,300,RC,87045,HCPCS,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,32.37,
GROUP B STREP CULT,1270776,CDM,300,RC,87070,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,50.63,
URINE CULTURE,1270777,CDM,300,RC,87088,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.13,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.13,23.24,
PH - FLUID,1270794,CDM,300,RC,83986,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,11.62,
RUBELLA IGM,1270795,CDM,300,RC,86762,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
GM1 IGG  AB,1270796,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
HEP C VIRAL LOAD,1270799,CDM,300,RC,87522,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,126.16,
HEP C RNA QUAL,1270800,CDM,300,RC,87521,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,58.1,
OSMOLALITY URINE,1270801,CDM,300,RC,83935,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6,28.22,
HOMOCYSTINE LEVEL,1270805,CDM,300,RC,83090,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,17.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
ANTI RO AB,1270806,CDM,300,RC,86235,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,105.41,
JO-1 AB,1270807,CDM,300,RC,86235,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,105.41,
MEASURE OF URINE VOL,1270813,CDM,300,RC,81050,HCPCS,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,3.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.64,9.96,
CHLORIDE URINE,1270814,CDM,300,RC,82436,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.42,15.77,
24HR MAGNESIUM URINE,1270815,CDM,300,RC,83735,HCPCS,outpatient,,,138,69,,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,107.64,78,,86.112,percent of total billed charges,78% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.54,83,,91.632,percent of total billed charges,83% of total billed charges for outpatient setting,69,50,,55.2,percent of total billed charges,50% of total billed charges for outpatient setting,69,50,,55.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,114.54,
URIC ACID URINE,1270816,CDM,300,RC,84560,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
HIV AB,1270818,CDM,300,RC,86703,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.71,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.47,40.67,
HYPOGLECEMIC SERUM,1270820,CDM,300,RC,83788,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
SENS-SPECIFIC DRUG,1270823,CDM,300,RC,87186,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,48.97,
RABIES AB TITER,1270824,CDM,300,RC,86790,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,76.36,
HEP B CORE AB(TOTAL),1270826,CDM,300,RC,86704,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,34.86,
ETHYLENE GLYCOL,1270830,CDM,300,RC,82693,HCPCS,outpatient,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.9,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.12,87.15,
URINE DIPSTICK,1270832,CDM,300,RC,81002,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,3.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,15.77,
FACTOR V,1270833,CDM,300,RC,85220,HCPCS,outpatient,,,125,62.5,,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.3,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,97.5,78,,78,percent of total billed charges,78% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,103.75,83,,83,percent of total billed charges,83% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.53,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.53,103.75,
MICRO SPOT TEST,1270836,CDM,300,RC,87077,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.11,104.58,
HEP B SURFACE AB QL,1270842,CDM,300,RC,86706,HCPCS,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,32.37,
E HISTOLYTICA AB (EIA),1270844,CDM,300,RC,86753,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.91,37.35,
AMYLASE ISOENZYMES,1270847,CDM,300,RC,82150,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,39.01,
LIPOPROTEIN LITTLE A,1270848,CDM,300,RC,82172,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,46.48,
T4 BY EQUIL DIALYSIS,1270850,CDM,300,RC,84439,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,53.12,
HEPATITIS A IGM,1270856,CDM,300,RC,86709,HCPCS,outpatient,,,161,80.5,,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,11.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.87,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,125.58,78,,100.464,percent of total billed charges,78% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.63,83,,106.904,percent of total billed charges,83% of total billed charges for outpatient setting,80.5,50,,64.4,percent of total billed charges,50% of total billed charges for outpatient setting,80.5,50,,64.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.91,133.63,
ANTI GBM,1270857,CDM,300,RC,86256,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,48.97,
PROINSULIN,1270860,CDM,300,RC,84206,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.52,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.68,104.58,
ANDROSTERIDINE,1270866,CDM,300,RC,82157,HCPCS,outpatient,,,207,103.5,,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,29.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,161.46,78,,129.168,percent of total billed charges,78% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.81,83,,137.448,percent of total billed charges,83% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.77,171.81,
GIARDIA ANTIGEN,1270868,CDM,300,RC,87328,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,35.69,
HLA DRB 345 HI RES,1270869,CDM,300,RC,81382,HCPCS,outpatient,,,370,185,,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,123.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,172.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,288.6,78,,230.88,percent of total billed charges,78% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,307.1,83,,245.68,percent of total billed charges,83% of total billed charges for outpatient setting,185,50,,148,percent of total billed charges,50% of total billed charges for outpatient setting,185,50,,148,percent of total billed charges,50% of total billed charges for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,123.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,307.1,
BARTONELLA AB,1275030,CDM,300,RC,86611,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.44,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,60.59,
HIV 1 & 2,1275031,CDM,300,RC,87536,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,85.1,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,56.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,153.55,
HERPES CULTURE (B),1275070,CDM,300,RC,87254,HCPCS,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,19.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,55.61,
HERPES CULTURE (B),1275071,CDM,300,RC,87207,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,17.43,
ALKA PHOSP ISOENZYME (B),1275072,CDM,300,RC,84075,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,14.94,
MYSOLINE (PRIMIDONE) (B),1275073,CDM,300,RC,80184,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.09,68.06,
ANA ANALYZER PANEL (B),1275074,CDM,300,RC,86376,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,83,
ANA ANALYZER PANEL (B),1275075,CDM,300,RC,86160,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,68.89,
ANA ANALYZER PANEL (B),1275076,CDM,300,RC,86256,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,68.89,
ANA ANALYZER PANEL (B),1275077,CDM,300,RC,86430,HCPCS,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,32.37,
ANA ANALYZER PANEL (B),1275078,CDM,300,RC,86255,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,68.89,
ANA ANALYZER PANEL (B),1275081,CDM,300,RC,86038,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,68.89,
GTT 3HR (B),1275085,CDM,300,RC,82952,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,15.77,
GTT 4HR (B),1275086,CDM,300,RC,82952,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,22.41,
GTT 5HR (B),1275087,CDM,300,RC,82952,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,28.22,
I & IBC (B),1275088,CDM,300,RC,83550,HCPCS,outpatient,,,26.16,13.08,,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,8.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,19.62,75,,15.696,percent of total billed charges,75% of total billed charges for outpatient setting,19.62,75,,15.696,percent of total billed charges,75% of total billed charges for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,19.62,75,,15.696,percent of total billed charges,75% of total billed charges for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.54,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.4,78,,16.32,percent of total billed charges,78% of total billed charges for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,18.31,70,,14.648,percent of total billed charges,70% of total billed charges for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.62,75,,15.696,percent of total billed charges,75% of total billed charges for outpatient setting,21.71,83,,17.368,percent of total billed charges,83% of total billed charges for outpatient setting,13.08,50,,10.464,percent of total billed charges,50% of total billed charges for outpatient setting,13.08,50,,10.464,percent of total billed charges,50% of total billed charges for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.69,21.71,
CATECHOLAMINES,1275093,CDM,300,RC,82384,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,74.7,
AFB CULTURE,1275285,CDM,300,RC,87118,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,45.65,
AFB STAIN,1275286,CDM,300,RC,87206,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,22.41,
ALKA PHOSP ISOENZYME (B),1275287,CDM,300,RC,84080,HCPCS,outpatient,,,102,51,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.52,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.56,78,,63.648,percent of total billed charges,78% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,84.66,83,,67.728,percent of total billed charges,83% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.01,84.66,
HERPES CULTURE (B),1275289,CDM,300,RC,87252,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,63.08,
MYSOLINE (PRIMIDONE) (B),1275290,CDM,300,RC,80188,HCPCS,outpatient,,,118,59,,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,16.59,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,92.04,78,,73.632,percent of total billed charges,78% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,82.6,70,,66.08,percent of total billed charges,70% of total billed charges for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.5,75,,70.8,percent of total billed charges,75% of total billed charges for outpatient setting,97.94,83,,78.352,percent of total billed charges,83% of total billed charges for outpatient setting,59,50,,47.2,percent of total billed charges,50% of total billed charges for outpatient setting,59,50,,47.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.6,97.94,
ANA ANALYZER PANEL (B),1275291,CDM,300,RC,86235,HCPCS,outpatient,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102.09,
FAST & 2 HR P PERAND (B),1275295,CDM,300,RC,82947,HCPCS,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,58.93,
FAST & 2 HR P GLUCOLA (B),1275296,CDM,300,RC,82947,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,31.54,
GTT 3HR (B),1275297,CDM,300,RC,82951,HCPCS,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,51.46,
GTT 4HR (B),1275298,CDM,300,RC,82951,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,73.04,
GTT 5HR (B),1275299,CDM,300,RC,82951,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,73.04,
I & IBC (B),1275300,CDM,300,RC,83540,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.71,19.09,
CATECHOLAMINES (B),1275301,CDM,300,RC,82570,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,29.88,
PROTEIN ELECTROPHO (B),1275312,CDM,300,RC,84165,HCPCS,outpatient,,,31.23,15.62,,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.36,78,,19.488,percent of total billed charges,78% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,25.92,83,,20.736,percent of total billed charges,83% of total billed charges for outpatient setting,15.62,50,,12.496,percent of total billed charges,50% of total billed charges for outpatient setting,15.62,50,,12.496,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,25.92,
PROTEIN ELECTROPHO (B),1275313,CDM,300,RC,84155,HCPCS,outpatient,,,10.97,5.49,,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.56,78,,6.848,percent of total billed charges,78% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,9.11,83,,7.288,percent of total billed charges,83% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,9.11,
RUBELLA TITER IGG&M (B),1275314,CDM,300,RC,86762,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
HEAVY METALS BLOOD (B),1275322,CDM,300,RC,82175,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,53.95,
HEAVY METALS BLOOD (B),1275323,CDM,300,RC,83655,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,34.86,
HEAVY METALS BLOOD (B),1275324,CDM,300,RC,83015,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,20.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.58,53.95,
MYCOPLASMA IGG,1275334,CDM,300,RC,86738,HCPCS,outpatient,,,144,72,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,112.32,78,,89.856,percent of total billed charges,78% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.52,83,,95.616,percent of total billed charges,83% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,119.52,
ENA AB (B),1275335,CDM,300,RC,86235,HCPCS,outpatient,,,172,86,,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,134.16,78,,107.328,percent of total billed charges,78% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,120.4,70,,96.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,142.76,83,,114.208,percent of total billed charges,83% of total billed charges for outpatient setting,86,50,,68.8,percent of total billed charges,50% of total billed charges for outpatient setting,86,50,,68.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,142.76,
ASPERGILLUS AB (B),1275339,CDM,300,RC,86606,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,60.59,
24 HR URINE CA (B),1275340,CDM,300,RC,82340,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.97,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.31,17.43,
24 HR URINE CA (B),1275341,CDM,300,RC,82310,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,56.44,
EPS BARR AB IGG & M (B),1275343,CDM,300,RC,86665,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,52.29,
MEXILETINE LEVEL (B),1275344,CDM,300,RC,80102,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
MEXILETINE LEVEL (B),1275345,CDM,300,RC,80299,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,68.89,
URINE PROTEIN ELECT (B),1275347,CDM,300,RC,84165,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,30.71,
URINE PROTEIN ELECT (B),1275348,CDM,300,RC,84160,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,14.94,
THY-STIMULATING IMM.,1275351,CDM,300,RC,84445,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,50.86,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,50.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.46,50.86,
THY-STIMULATING IMM. (B),1275352,CDM,300,RC,84443,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,48.14,
PROTEIN S&C DETERMIN (B),1275353,CDM,300,RC,85303,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,13.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.17,113.71,
PROTEIN S&C DETERMIN (B),1275354,CDM,300,RC,85306,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.49,113.71,
IMMUNOGLOBULINS G QUANT SUBCLA,1275355,CDM,300,RC,82784,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,27.39,
IMMUNOGLOBULINS G QUANT SUBCLA,1275356,CDM,300,RC,82787,HCPCS,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,8.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.58,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.06,24.07,
GTT 6HR (B),1275357,CDM,300,RC,82951,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,73.04,
GTT 6HR (B),1275358,CDM,300,RC,82952,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,22.41,
TRIPLE TEST (B),1275390,CDM,300,RC,82105,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,16.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.77,95.45,
TRIPLE TEST (B),1275391,CDM,300,RC,82677,HCPCS,outpatient,,,166,83,,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,24.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,30.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,129.48,78,,103.584,percent of total billed charges,78% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.78,83,,110.224,percent of total billed charges,83% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.29,137.78,
TRIPLE TEST (B),1275392,CDM,300,RC,84702,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,36.52,
PNEUMOCYSTIS CARINII (B),1275393,CDM,300,RC,87205,HCPCS,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,14.11,
PNEUMOCYSTIS CARINII (B),1275394,CDM,300,RC,87207,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.27,35.69,
PNEUMOCYSTIS CARINII (B),1275395,CDM,300,RC,87210,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,24.9,
ERLICHIOSIS TITER (B),1275407,CDM,300,RC,86666,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.44,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,58.1,
CD4 CD8 & ABSOLUTE(B),1275411,CDM,300,RC,86360,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,134.46,
MENINGOENCEPHALITIS (B),1275415,CDM,300,RC,86694,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,68.89,
MENINGOENCEPHALITIS (B),1275416,CDM,300,RC,86652,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
MENINGOENCEPHALITIS (B),1275417,CDM,300,RC,86651,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
MENINGOENCEPHALITIS (B),1275418,CDM,300,RC,86653,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
MENINGOENCEPHALITIS (B),1275419,CDM,300,RC,86787,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,76.36,
MENINGOENCEPHALITIS (B),1275420,CDM,300,RC,86654,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
MENINGOENCEPHALITIS (B),1275421,CDM,300,RC,86790,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,76.36,
MENINGOENCEPHALITIS (B),1275422,CDM,300,RC,86735,HCPCS,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,77.19,
MENINGOENCEPHALITIS (B),1275423,CDM,300,RC,86765,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,76.36,
MENINGOENCEPHALITIS (B),1275424,CDM,300,RC,86727,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,75.53,
BRUCELLOSIS IG G & M (B),1275433,CDM,300,RC,86622,HCPCS,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.86,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.86,25.73,
ARBOVIRUS ANTIBODIES (B),1275434,CDM,300,RC,86651,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
ARBOVIRUS ANTIBODIES (B),1275435,CDM,300,RC,86652,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
ARBOVIRUS ANTIBODIES (B),1275436,CDM,300,RC,86653,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
ARBOVIRUS ANTIBODIES (B),1275438,CDM,300,RC,86654,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
CARDIOLIPIN AB (B),1275439,CDM,300,RC,86147,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,73.04,
MUMPS VIRUS IGM & G (B),1275440,CDM,300,RC,86735,HCPCS,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,77.19,
TOXOPLASMA AB IGG&M (B),1275441,CDM,300,RC,86777,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,92.96,
TOXOPLASMA AB IGG&M (B),1275442,CDM,300,RC,86778,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,115.37,
CMV IGM & IGG (B),1275443,CDM,300,RC,86645,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,134.46,
CMV IGM & IGG (B),1275444,CDM,300,RC,86644,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,92.96,
CYTOGENETICS,1275446,CDM,300,RC,88262,HCPCS,outpatient,,,882,441,,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,687.96,78,,550.368,percent of total billed charges,78% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,732.06,83,,585.648,percent of total billed charges,83% of total billed charges for outpatient setting,441,50,,352.8,percent of total billed charges,50% of total billed charges for outpatient setting,441,50,,352.8,percent of total billed charges,50% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,732.06,
HERPES VIRUS IGG ANT (B),1275452,CDM,300,RC,86694,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,33.2,
HERPES VIRUS IGG ANT (B),1275453,CDM,300,RC,86694,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,33.2,
HERPES VIRUS IGM ANT (B),1275454,CDM,300,RC,86695,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
HERPES VIRUS IGM ANT (B),1275455,CDM,300,RC,86694,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
ANTITHROMBIN III (B),1275456,CDM,300,RC,85300,HCPCS,outpatient,,,113,56.5,,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,11.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,88.14,78,,70.512,percent of total billed charges,78% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.79,83,,75.032,percent of total billed charges,83% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.43,93.79,
ANTITHROMBIN III (B),1275457,CDM,300,RC,85301,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,10.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.52,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.52,86.32,
LEU/LYMPH PROFILE (B),1275458,CDM,300,RC,88184,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.27,308.75,
LEU/LYMPH PROFILE(B),1275459,CDM,300,RC,88185,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.87,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.87,70.55,
LEU/LYMPH PROFILE(B),1275460,CDM,300,RC,88189,HCPCS,outpatient,,,224,112,,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,174.72,78,,139.776,percent of total billed charges,78% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,185.92,83,,148.736,percent of total billed charges,83% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.78,185.92,
THYROID ANTIBODY PAN (B),1275468,CDM,300,RC,86376,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,41.5,
THYROID ANTIBODY PAN (B),1275469,CDM,300,RC,86800,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,45.65,
BACTERIAL ANTIGEN (B),1275486,CDM,300,RC,86403,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,11.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,58.1,
HEAVY METALS URINE (B),1275487,CDM,300,RC,82175,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,53.95,
HEAVY METALS URINE (B),1275488,CDM,300,RC,83655,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,34.86,
HEAVY METALS URINE (B),1275489,CDM,300,RC,83825,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,16.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.32,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.32,46.48,
SAP 10 DRUG SCREEN (B),1275493,CDM,300,RC,80301,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
SAP 6 DRUG SCREEN (B),1275494,CDM,300,RC,80301,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
PARVO B19 AB PANEL IGG & IGM (,1275497,CDM,300,RC,86747,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.85,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.23,87.98,
IMMUNOFIXATION EVAL (B),1275500,CDM,300,RC,86334,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.66,127.82,
IMMUNOFIXATION EVAL (B),1275501,CDM,300,RC,82784,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,53.12,
VITAMIN D,1275504,CDM,300,RC,82652,HCPCS,outpatient,,,518,259,,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,48.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,388.5,75,,310.8,percent of total billed charges,75% of total billed charges for outpatient setting,388.5,75,,310.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,388.5,75,,310.8,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,404.04,78,,323.232,percent of total billed charges,78% of total billed charges for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,362.6,70,,290.08,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,388.5,75,,310.8,percent of total billed charges,75% of total billed charges for outpatient setting,429.94,83,,343.952,percent of total billed charges,83% of total billed charges for outpatient setting,259,50,,207.2,percent of total billed charges,50% of total billed charges for outpatient setting,259,50,,207.2,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.88,429.94,
VITAMIN D (B),1275505,CDM,300,RC,82306,HCPCS,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,29.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.08,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.05,199.2,
VON WILLEBRAND FACTOR AG,1275507,CDM,300,RC,85246,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,135.29,
LUPUS ANTICOAGULANT (B),1275509,CDM,300,RC,85613,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,54.78,
LUPUS ANTICOAGULANT (B),1275510,CDM,300,RC,85730,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.28,34.03,
LUPUS ANTICOAGULANT (B),1275511,CDM,300,RC,85610,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.46,22.41,
ANTI-PHOSPHOLIPID AB (B),1275527,CDM,300,RC,86147,HCPCS,outpatient,,,210,105,,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,163.8,78,,131.04,percent of total billed charges,78% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,83,,139.44,percent of total billed charges,83% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,174.3,
ANTI-PHOSPHOLIPID AB (B),1275528,CDM,300,RC,83520,HCPCS,outpatient,,,107,53.5,,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,80.25,75,,64.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.25,75,,64.2,percent of total billed charges,75% of total billed charges for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,80.25,75,,64.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,83.46,78,,66.768,percent of total billed charges,78% of total billed charges for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,74.9,70,,59.92,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.25,75,,64.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.81,83,,71.048,percent of total billed charges,83% of total billed charges for outpatient setting,53.5,50,,42.8,percent of total billed charges,50% of total billed charges for outpatient setting,53.5,50,,42.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,88.81,
ANTI-PHOSPHOLIPID AB (B),1275529,CDM,300,RC,85613,HCPCS,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,65.57,
BLOOD CULT FOR MAC (B),1275530,CDM,300,RC,87118,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,35,,21,percent of total billed charges,35% of total billed charges for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,39.17,,23.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,14.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,62.25,
BLOOD CULT FOR MAC (B),1275531,CDM,300,RC,87206,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,30.71,
MYASTHENIA GRAVIS (B),1275535,CDM,300,RC,83519,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,40.67,
FUNGAL AB PANEL (B),1275537,CDM,300,RC,86698,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,39.01,
FUNGAL AB PANEL (B),1275538,CDM,300,RC,86612,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.36,76.36,
FUNGAL AB PANEL (B),1275539,CDM,300,RC,86635,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.1,68.06,
FUNGAL AB PANEL (B),1275540,CDM,300,RC,86606,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,89.64,
PTH N-TERMINAL (B),1275541,CDM,300,RC,83970,HCPCS,outpatient,,,293,146.5,,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,228.54,78,,182.832,percent of total billed charges,78% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.19,83,,194.552,percent of total billed charges,83% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,243.19,
PTH N-TERMINAL (B),1275542,CDM,300,RC,82310,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,30.71,
PTH C-TERMINAL (B),1275543,CDM,300,RC,83970,HCPCS,outpatient,,,293,146.5,,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,228.54,78,,182.832,percent of total billed charges,78% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.19,83,,194.552,percent of total billed charges,83% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,243.19,
PTH C-TERMINAL (B),1275544,CDM,300,RC,82310,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,30.71,
PTH INTACT - IRMA (B),1275545,CDM,300,RC,83970,HCPCS,outpatient,,,293,146.5,,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,228.54,78,,182.832,percent of total billed charges,78% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.19,83,,194.552,percent of total billed charges,83% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,41.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,243.19,
PTH INTACT - IRMA,1275546,CDM,300,RC,82310,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,30.71,
EBV AB PANEL(B),1275557,CDM,300,RC,86665,HCPCS,outpatient,,,222,111,,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,173.16,78,,138.528,percent of total billed charges,78% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.26,83,,147.408,percent of total billed charges,83% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,184.26,
EBV AB PANEL(P),1275558,CDM,300,RC,86664,HCPCS,outpatient,,,178,89,,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,15.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,133.5,75,,106.8,percent of total billed charges,75% of total billed charges for outpatient setting,133.5,75,,106.8,percent of total billed charges,75% of total billed charges for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,133.5,75,,106.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,138.84,78,,111.072,percent of total billed charges,78% of total billed charges for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,124.6,70,,99.68,percent of total billed charges,70% of total billed charges for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133.5,75,,106.8,percent of total billed charges,75% of total billed charges for outpatient setting,147.74,83,,118.192,percent of total billed charges,83% of total billed charges for outpatient setting,89,50,,71.2,percent of total billed charges,50% of total billed charges for outpatient setting,89,50,,71.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.47,147.74,
EBV AB PANEL(B),1275559,CDM,300,RC,86665,HCPCS,outpatient,,,222,111,,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,173.16,78,,138.528,percent of total billed charges,78% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.26,83,,147.408,percent of total billed charges,83% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,184.26,
THC METABOLITE-SERUM (B),1275565,CDM,300,RC,80301,HCPCS,outpatient,,,145,72.5,,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.75,35,,40.6,percent of total billed charges,35% of total billed charges for outpatient setting,113.1,78,,90.48,percent of total billed charges,78% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,120.35,83,,96.28,percent of total billed charges,83% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.79,39.17,,45.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,50.75,120.35,
THC METABOLITE-SERUM (B),1275566,CDM,300,RC,82542,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,24.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,53.12,
LIVER FIBROSIS,1275567,CDM,300,RC,81596,HCPCS,outpatient,,,360,180,,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,72.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,57.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,280.8,78,,224.64,percent of total billed charges,78% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,298.8,83,,239.04,percent of total billed charges,83% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,72.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.43,298.8,
EBV-VCA IGG & IGM (B),1275578,CDM,300,RC,86665,HCPCS,outpatient,,,175,87.5,,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,136.5,78,,109.2,percent of total billed charges,78% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,145.25,83,,116.2,percent of total billed charges,83% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.97,145.25,
GC/CHLAMY GENPROBE (B),1275584,CDM,300,RC,87490,HCPCS,outpatient,,,136,68,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,22.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.08,78,,84.864,percent of total billed charges,78% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.88,83,,90.304,percent of total billed charges,83% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.36,112.88,
DIPTHERIA/TETANUS (B),1275608,CDM,300,RC,86317,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,81.34,
DIPTHERIA/TETANUS (B),1275609,CDM,300,RC,86317,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,81.34,
TESTOSTERONE-FREE (B),1275610,CDM,300,RC,84402,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.61,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.41,75.53,
TESTOSTERONE-FREE (B),1275611,CDM,300,RC,84403,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,76.36,
ANCA (B),1275614,CDM,300,RC,86255,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,48.14,
TORCH TITER-IGG&IGM (B),1275616,CDM,300,RC,86645,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,96.28,
TORCH TITER-IGG&IGM (B),1275617,CDM,300,RC,86695,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
TORCH TITER-IGG&IGM (B),1275618,CDM,300,RC,86696,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,110.39,
TORCH TITER-IGG&IGM (B),1275620,CDM,300,RC,86778,HCPCS,outpatient,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,82.17,
HERPES SIMPLEX PANEL,1275621,CDM,300,RC,86696,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,113.71,
HERPES SIMPLEX VIRUS AB PANEL,1275622,CDM,300,RC,86695,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
COMPATIBILITY TEST SCBC(B),1275623,CDM,300,RC,86920,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.3,35,,44.24,percent of total billed charges,35% of total billed charges for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.88,39.17,,49.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.33,146.71,
COMPATIBILITY TEST SCBC(B),1275624,CDM,300,RC,86921,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,30.1,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.35,146.71,
COMPATIBILITY TEST SCBC(B),1275625,CDM,300,RC,86922,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.3,35,,44.24,percent of total billed charges,35% of total billed charges for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.88,39.17,,49.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.6,146.71,
Q FEVER IGG AB,1275638,CDM,300,RC,86638,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.68,71.38,
COXSACKIE A VIRUS AB (B),1275651,CDM,300,RC,86658,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,74.7,
FACTOR 8 VON WILLEBRAND (B),1275657,CDM,300,RC,85240,HCPCS,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,51.46,
FACTOR 8 VON WILLEBRAND (B),1275658,CDM,300,RC,85246,HCPCS,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,65.57,
FACTOR 8 VON WILLEBRAND (B),1275659,CDM,300,RC,85247,HCPCS,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,65.57,
THYROGLOBULIN,1276444,CDM,300,RC,84432,HCPCS,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,16.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.14,47.31,
THYROGLOBULIN (B),1276445,CDM,300,RC,86800,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,45.65,
VIRAL CULTURE,1276569,CDM,300,RC,87252,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,126.16,
HSV PHENOTYPING,1276570,CDM,300,RC,87253,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,20.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.34,92.96,
CMV - RAPID & ROUTINE (B),1276573,CDM,300,RC,87252,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.46,63.08,
CMV - RAPID & ROUTINE (B),1276574,CDM,300,RC,87254,HCPCS,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,19.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,55.61,
SSB AB,1276580,CDM,300,RC,86235,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,53.12,
IMMUNOGLOBULINS (B),1276581,CDM,300,RC,82784,HCPCS,outpatient,,,44.8,22.4,,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.94,78,,27.952,percent of total billed charges,78% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,37.18,83,,29.744,percent of total billed charges,83% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,37.18,
ADSORPTION (B),1276582,CDM,300,RC,86970,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.3,35,,44.24,percent of total billed charges,35% of total billed charges for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.88,39.17,,49.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,131.14,
ADSORPTION (B),1276583,CDM,300,RC,86975,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.3,35,,44.24,percent of total billed charges,35% of total billed charges for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.88,39.17,,49.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.3,342.25,
Q FEVER IGM AB,1276584,CDM,300,RC,86638,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.68,99.6,
RICKETTSIAL PANEL (B),1276585,CDM,300,RC,86256,HCPCS,outpatient,,,235,117.5,,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,183.3,78,,146.64,percent of total billed charges,78% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,195.05,83,,156.04,percent of total billed charges,83% of total billed charges for outpatient setting,117.5,50,,94,percent of total billed charges,50% of total billed charges for outpatient setting,117.5,50,,94,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,195.05,
CHLAMYDIA IGG,1276586,CDM,300,RC,86631,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.61,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,69.72,
CHLAMYDIA IGM,1276587,CDM,300,RC,86632,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,74.7,
HERPES SIMPLEX 2 BY PC,1276588,CDM,300,RC,87529,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,58.1,
TORCH TITER-IGG&IGM(B),1276592,CDM,300,RC,86762,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
HEP C GENOTYPE (B),1276593,CDM,300,RC,83894,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
HEP C GENOTYPE (B),1276594,CDM,300,RC,83902,HCPCS,outpatient,,,79,39.5,,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.34,38.4,,24.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.34,38.4,,24.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.65,35,,22.12,percent of total billed charges,35% of total billed charges for outpatient setting,61.62,78,,49.296,percent of total billed charges,78% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,55.3,70,,44.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.25,75,,47.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.57,83,,52.456,percent of total billed charges,83% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,39.5,50,,31.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.95,39.17,,24.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.65,65.57,
HEP C GENOTYPE (B),1276595,CDM,300,RC,83898,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
HEP C GENOTYPE (B),1276596,CDM,300,RC,83892,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
HEP C GENOTYPE (B),1276597,CDM,300,RC,83912,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
GLIADIN IGG AND IGA ABS (B),1276600,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
INFLUENZAE A,1276603,CDM,300,RC,87400,HCPCS,outpatient,,,140.95,70.48,,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,14.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,109.94,78,,87.952,percent of total billed charges,78% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,116.99,83,,93.592,percent of total billed charges,83% of total billed charges for outpatient setting,70.48,50,,56.384,percent of total billed charges,50% of total billed charges for outpatient setting,70.48,50,,56.384,percent of total billed charges,50% of total billed charges for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,116.99,
INFLUENZAE B,1276604,CDM,300,RC,87400,HCPCS,outpatient,,,140.95,70.48,,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,14.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,109.94,78,,87.952,percent of total billed charges,78% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,98.67,70,,78.936,percent of total billed charges,70% of total billed charges for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.71,75,,84.568,percent of total billed charges,75% of total billed charges for outpatient setting,116.99,83,,93.592,percent of total billed charges,83% of total billed charges for outpatient setting,70.48,50,,56.384,percent of total billed charges,50% of total billed charges for outpatient setting,70.48,50,,56.384,percent of total billed charges,50% of total billed charges for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,116.99,
GC/CHLAMY GENPROBE (B),1276605,CDM,300,RC,87590,HCPCS,outpatient,,,136,68,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,26.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.6,35,,38.08,percent of total billed charges,35% of total billed charges for outpatient setting,106.08,78,,84.864,percent of total billed charges,78% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.88,83,,90.304,percent of total billed charges,83% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,68,50,,54.4,percent of total billed charges,50% of total billed charges for outpatient setting,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.26,39.17,,42.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,26.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.88,112.88,
FUNGUS CULTURE OTHER THAN HAIR,1276611,CDM,300,RC,87102,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.4,24.9,
BB PLT POOLING,1276612,CDM,300,RC,86965,HCPCS,outpatient,,,311,155.5,,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,119.42,38.4,,95.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.42,38.4,,95.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,233.25,75,,186.6,percent of total billed charges,75% of total billed charges for outpatient setting,233.25,75,,186.6,percent of total billed charges,75% of total billed charges for outpatient setting,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,233.25,75,,186.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.85,35,,87.08,percent of total billed charges,35% of total billed charges for outpatient setting,242.58,78,,194.064,percent of total billed charges,78% of total billed charges for outpatient setting,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,217.7,70,,174.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.25,75,,186.6,percent of total billed charges,75% of total billed charges for outpatient setting,258.13,83,,206.504,percent of total billed charges,83% of total billed charges for outpatient setting,155.5,50,,124.4,percent of total billed charges,50% of total billed charges for outpatient setting,155.5,50,,124.4,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.81,39.17,,97.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.85,258.13,
TORCH TITER IGM,1276613,CDM,300,RC,86778,HCPCS,outpatient,,,102,51,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.56,78,,63.648,percent of total billed charges,78% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,84.66,83,,67.728,percent of total billed charges,83% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,84.66,
TORCH TITER-IGM(B),1276614,CDM,300,RC,86762,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
TORCH TITER-IGM(B),1276615,CDM,300,RC,86645,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,96.28,
TORCH TITER-IGM(B),1276616,CDM,300,RC,86695,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
TORCH TITER-IGM(B),1276617,CDM,300,RC,86696,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,110.39,
CHLAMYDIA PSITTACI (B),1276618,CDM,300,RC,86631,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.61,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,67.23,
CHLAMYDIA PSITTACI (B),1276619,CDM,300,RC,86632,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,72.21,
CHLAMYDIA PNEUM (B),1276620,CDM,300,RC,86631,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.61,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.41,67.23,
CHLAMYDIA PNEUM (B),1276621,CDM,300,RC,86632,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,72.21,
PROTHOMBIN NUCLEOTIDE 20210 G/,1276622,CDM,300,RC,83891,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
PROTHOMBIN NUCLEOTIDE 20210 G/,1276623,CDM,300,RC,83898,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
PROTHOMBIN NUCLEOTIDE 20210 G/,1276624,CDM,300,RC,83896,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,36.52,
PROTHOMBIN NUCLEOTIDE 20210 G/,1276625,CDM,300,RC,83912,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
PROTHOMBIN NUCLEOTIDE 20210 G/,1276626,CDM,300,RC,83903,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
FACTOR V LEIDEN BY PCR (B),1276627,CDM,300,RC,83891,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
FACTOR V LEIDEN BY PCR (B),1276628,CDM,300,RC,83896,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
FACTOR V LEIDEN BY PCR (B),1276629,CDM,300,RC,83900,HCPCS,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
FACTOR V LEIDEN BY PCR (B),1276630,CDM,300,RC,83909,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
FACTOR V LEIDEN BY PCR (B),1276631,CDM,300,RC,83912,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
MTHFR LEVEL (B),1276632,CDM,300,RC,83891,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
MTHFR LEVEL (B),1276633,CDM,300,RC,83898,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
MTHFR LEVEL (B),1276634,CDM,300,RC,83896,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
MTHFR LEVEL (B),1276635,CDM,300,RC,83903,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
MTHFR LEVEL (B),1276636,CDM,300,RC,83912,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
GLUTEN SENS PANEL (B),1276637,CDM,300,RC,83516,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,60.59,
GLUTEN SENS PANEL (B),1276638,CDM,300,RC,86255,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,68.89,
GLUTEN SENS PANEL (B),1276639,CDM,300,RC,83516,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,60.59,
SOUTHEASTERN RAST (1 OF 3 BUNDLE),1276641,CDM,300,RC,86003,HCPCS,outpatient,,,26.6,13.3,,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.75,78,,16.6,percent of total billed charges,78% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,83,,17.664,percent of total billed charges,83% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,22.08,
SAP 10 CO(B),1276642,CDM,300,RC,80301,HCPCS,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
PT G20210 MUTATION (B),1276644,CDM,300,RC,83891,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
PT G20210 MUTATION (B),1276645,CDM,300,RC,83898,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
PT G20210 MUTATION (B),1276646,CDM,300,RC,83896,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
PT G20210 MUTATION (B),1276647,CDM,300,RC,83912,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
PT G20210 MUTATION (B),1276648,CDM,300,RC,83890,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
HISTOPLASMA AB (B),1276649,CDM,300,RC,86698,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,73.87,
PNEUMOCOCCAL AB(B),1276650,CDM,300,RC,86609,HCPCS,outpatient,,,65.8,32.9,,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,49.35,75,,39.48,percent of total billed charges,75% of total billed charges for outpatient setting,49.35,75,,39.48,percent of total billed charges,75% of total billed charges for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,49.35,75,,39.48,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,51.32,78,,41.056,percent of total billed charges,78% of total billed charges for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,46.06,70,,36.848,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,75,,39.48,percent of total billed charges,75% of total billed charges for outpatient setting,54.61,83,,43.688,percent of total billed charges,83% of total billed charges for outpatient setting,32.9,50,,26.32,percent of total billed charges,50% of total billed charges for outpatient setting,32.9,50,,26.32,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,54.61,
LDH ISOENZYMES (B),1276651,CDM,300,RC,83625,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.19,66.4,
LDH ISOENZYMES (B),1276652,CDM,300,RC,83615,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,34.86,
CHARGE FOR MANUAL DIFF,1276653,CDM,300,RC,85007,HCPCS,outpatient,,,24.48,12.24,,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.09,78,,15.272,percent of total billed charges,78% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,83,,16.256,percent of total billed charges,83% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.03,20.32,
DILUTE RUSSELL VIPER VENOM,1276655,CDM,300,RC,85613,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.42,56.44,
"FRAGILE X,CHROM AND DNA (B)",1276658,CDM,300,RC,88262,HCPCS,outpatient,,,882,441,,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,687.96,78,,550.368,percent of total billed charges,78% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,617.4,70,,493.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,661.5,75,,529.2,percent of total billed charges,75% of total billed charges for outpatient setting,732.06,83,,585.648,percent of total billed charges,83% of total billed charges for outpatient setting,441,50,,352.8,percent of total billed charges,50% of total billed charges for outpatient setting,441,50,,352.8,percent of total billed charges,50% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,732.06,
"FRAGILE X,CHROM AND DNA (B)",1276659,CDM,300,RC,83890,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
"FRAGILE X,CHROM AND DNA (B)",1276660,CDM,300,RC,83892,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
"FRAGILE X,CHROM AND DNA (B)",1276661,CDM,300,RC,83894,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
"FRAGILE X,CHROM AND DNA (B)",1276662,CDM,300,RC,83898,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
"FRAGILE X,CHROM AND DNA (B)",1276663,CDM,300,RC,88230,HCPCS,outpatient,,,825,412.5,,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,116.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,146.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,146.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,618.75,75,,495,percent of total billed charges,75% of total billed charges for outpatient setting,618.75,75,,495,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,618.75,75,,495,percent of total billed charges,75% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,643.5,78,,514.8,percent of total billed charges,78% of total billed charges for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,70,,462,percent of total billed charges,70% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,618.75,75,,495,percent of total billed charges,75% of total billed charges for outpatient setting,684.75,83,,547.8,percent of total billed charges,83% of total billed charges for outpatient setting,412.5,50,,330,percent of total billed charges,50% of total billed charges for outpatient setting,412.5,50,,330,percent of total billed charges,50% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.54,684.75,
"FRAGILE X,CHROM AND DNA (B)",1276664,CDM,300,RC,88280,HCPCS,outpatient,,,179,89.5,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,139.62,78,,111.696,percent of total billed charges,78% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,148.57,83,,118.856,percent of total billed charges,83% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,148.57,
"FRAGILE X,CHROM AND DNA (B)",1276665,CDM,300,RC,83912,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
CHROMOSOME HI RES ANALYSIS(B),1276666,CDM,300,RC,88262,HCPCS,outpatient,,,857,428.5,,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,642.75,75,,514.2,percent of total billed charges,75% of total billed charges for outpatient setting,642.75,75,,514.2,percent of total billed charges,75% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,642.75,75,,514.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,668.46,78,,534.768,percent of total billed charges,78% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,642.75,75,,514.2,percent of total billed charges,75% of total billed charges for outpatient setting,711.31,83,,569.048,percent of total billed charges,83% of total billed charges for outpatient setting,428.5,50,,342.8,percent of total billed charges,50% of total billed charges for outpatient setting,428.5,50,,342.8,percent of total billed charges,50% of total billed charges for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,125.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,711.31,
CHROMOSOME HI RES ANALYSIS(B),1276667,CDM,300,RC,88230,HCPCS,outpatient,,,801,400.5,,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,116.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,146.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,146.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,600.75,75,,480.6,percent of total billed charges,75% of total billed charges for outpatient setting,600.75,75,,480.6,percent of total billed charges,75% of total billed charges for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,600.75,75,,480.6,percent of total billed charges,75% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,624.78,78,,499.824,percent of total billed charges,78% of total billed charges for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,560.7,70,,448.56,percent of total billed charges,70% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,600.75,75,,480.6,percent of total billed charges,75% of total billed charges for outpatient setting,664.83,83,,531.864,percent of total billed charges,83% of total billed charges for outpatient setting,400.5,50,,320.4,percent of total billed charges,50% of total billed charges for outpatient setting,400.5,50,,320.4,percent of total billed charges,50% of total billed charges for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,116.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.54,664.83,
CHROMOSOME HI RES ANALYSIS(B),1276668,CDM,300,RC,88289,HCPCS,outpatient,,,237,118.5,,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,34.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,43.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,177.75,75,,142.2,percent of total billed charges,75% of total billed charges for outpatient setting,177.75,75,,142.2,percent of total billed charges,75% of total billed charges for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,177.75,75,,142.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,184.86,78,,147.888,percent of total billed charges,78% of total billed charges for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,165.9,70,,132.72,percent of total billed charges,70% of total billed charges for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177.75,75,,142.2,percent of total billed charges,75% of total billed charges for outpatient setting,196.71,83,,157.368,percent of total billed charges,83% of total billed charges for outpatient setting,118.5,50,,94.8,percent of total billed charges,50% of total billed charges for outpatient setting,118.5,50,,94.8,percent of total billed charges,50% of total billed charges for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.31,196.71,
CHROMOSOME HI RES ANALYSIS(B),1276669,CDM,300,RC,88280,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,143.59,
LEISHMANIA AB(B),1276670,CDM,300,RC,86717,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,69.72,
LYME IGG & IGM WESTERN BLOT (B,1276671,CDM,300,RC,86617,HCPCS,outpatient,,,254,127,,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.45,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,198.12,78,,158.496,percent of total billed charges,78% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,210.82,83,,168.656,percent of total billed charges,83% of total billed charges for outpatient setting,127,50,,101.6,percent of total billed charges,50% of total billed charges for outpatient setting,127,50,,101.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,210.82,
CD4 CD8 & ABSOLU(B),1276672,CDM,300,RC,86359,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,67.23,
MMR TITER (B),1276674,CDM,300,RC,86765,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,73.87,
MMR TITER (B),1276675,CDM,300,RC,86735,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,74.7,
MMR TITER (B),1276676,CDM,300,RC,86762,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
ANCA WITH TITER & MPO/PR3(B),1276677,CDM,300,RC,86255,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,34.86,
ANCA WITH TITER & MPO/PR3(B),1276678,CDM,300,RC,86256,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,34.86,
ANCA WITH TITER & MPO/PR3(B),1276679,CDM,300,RC,83516,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,30.71,
"ENCEPHALITIS PANEL, SERUM (B)",1276680,CDM,300,RC,86765,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,73.87,
"ENCEPHALITIS PANEL, SERUM (B)",1276681,CDM,300,RC,86735,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,74.7,
"ENCEPHALITIS PANEL, SERUM (B)",1276682,CDM,300,RC,86787,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,73.87,
"ENCEPHALITIS PANEL, SERUM (B)",1276683,CDM,300,RC,86727,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,73.04,
"ENCEPHALITIS PANEL, SERUM (B)",1276684,CDM,300,RC,86694,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
"ENCEPHALITIS PANEL, SERUM (B)",1276685,CDM,300,RC,86695,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,75.53,
"ENCEPHALITIS PANEL, SERUM (B)",1276686,CDM,300,RC,86696,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,110.39,
HYPER PNEUMONITIS EXT PANEL (B,1276687,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
HYPER PNEUMONITIS EXT PANEL (B,1276688,CDM,300,RC,86331,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,68.06,
SACCHAROMYCES CEREVISIAE AB,1276689,CDM,300,RC,86671,HCPCS,outpatient,,,176,88,,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,137.28,78,,109.824,percent of total billed charges,78% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.08,83,,116.864,percent of total billed charges,83% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,146.08,
FECAL ELECT(B),1276691,CDM,300,RC,84999,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.4,69.72,
FECAL ELECT(B),1276692,CDM,300,RC,84302,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.86,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.86,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,19.92,
FECAL ELECT(B),1276693,CDM,300,RC,82438,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,28.22,
BABESIA AB IGG AND IGG (B),1276694,CDM,300,RC,86753,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.91,70.55,
ALP PHOS FRACT (B),1276695,CDM,300,RC,84075,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,29.88,
ALP PHOS FRACT (B),1276696,CDM,300,RC,84078,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,8.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,41.5,
HER HEMOCHROMATIOSIS DNA MUTAT,1276697,CDM,300,RC,83891,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
HER HEMOCHROMATIOSIS DNA MUTAT,1276698,CDM,300,RC,83900,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
HER HEMOCHROMATIOSIS DNA MUTAT,1276699,CDM,300,RC,83892,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
HER HEMOCHROMATIOSIS DNA MUTAT,1276700,CDM,300,RC,83909,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
HER HEMOCHROMATIOSIS DNA MUTAT,1276701,CDM,300,RC,83912,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
JAK2 MUTATION (B),1276702,CDM,300,RC,81270,HCPCS,outpatient,,,314,157,,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,91.66,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,72,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,244.92,78,,195.936,percent of total billed charges,78% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,260.62,83,,208.496,percent of total billed charges,83% of total billed charges for outpatient setting,157,50,,125.6,percent of total billed charges,50% of total billed charges for outpatient setting,157,50,,125.6,percent of total billed charges,50% of total billed charges for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,91.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,260.62,
JAK2 MUTATION (B),1276703,CDM,300,RC,81207,HCPCS,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,144.84,
JAK2 MUTATION (B),1276704,CDM,300,RC,81401,HCPCS,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,137,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,112,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,112,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,137,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,137,
JAK2 MUTATION (B),1276705,CDM,300,RC,81403,HCPCS,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,185.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,188,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.4,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,185.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,197.4,
PROTEIN URINE,1276707,CDM,300,RC,84156,HCPCS,outpatient,,,26.6,13.3,,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.75,78,,16.6,percent of total billed charges,78% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,83,,17.664,percent of total billed charges,83% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.23,22.08,
BETA 2 GLYCOPROTEIN (B),1276708,CDM,300,RC,86146,HCPCS,outpatient,,,175,87.5,,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,136.5,78,,109.2,percent of total billed charges,78% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,145.25,83,,116.2,percent of total billed charges,83% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,87.5,50,,70,percent of total billed charges,50% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,145.25,
FACTOR V LEIDEN BY PCR (B),1276709,CDM,300,RC,83914,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
B PERTUSSIS/PARAPERTUSSIS DNA,1276710,CDM,300,RC,87798,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,58.1,
INFLUENZA  A PCR,1276712,CDM,300,RC,87636,HCPCS,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,149.76,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77,149.76,
INFLUENZA B PCR,1276713,CDM,300,RC,87636,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,149.76,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.5,149.76,
COVID 19 & FLU A/B PCR (B),1276714,CDM,300,RC,87636,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,149.76,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,142.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.5,149.76,
INFLUENZA  A  ANTIGEN,1276716,CDM,300,RC,87428,HCPCS,outpatient,,,102.12,51.06,,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.65,78,,63.72,percent of total billed charges,78% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,83,,67.808,percent of total billed charges,83% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,84.76,
INFLUENZA B ANTIGEN,1276717,CDM,300,RC,87428,HCPCS,outpatient,,,102.12,51.06,,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.65,78,,63.72,percent of total billed charges,78% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,83,,67.808,percent of total billed charges,83% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,84.76,
.COVID ANTIGEN COMBO CHARGE,1276718,CDM,300,RC,87428,HCPCS,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,70.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.96,100.43,
TROPONIN-HS,1276719,CDM,300,RC,84484,HCPCS,outpatient,,,59.08,29.54,,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.08,78,,36.864,percent of total billed charges,78% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,49.04,83,,39.232,percent of total billed charges,83% of total billed charges for outpatient setting,29.54,50,,23.632,percent of total billed charges,50% of total billed charges for outpatient setting,29.54,50,,23.632,percent of total billed charges,50% of total billed charges for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.67,49.04,
D DIMER,1276720,CDM,300,RC,85379,HCPCS,outpatient,,,153.61,76.81,,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,12.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.44,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,119.82,78,,95.856,percent of total billed charges,78% of total billed charges for outpatient setting,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.21,75,,92.168,percent of total billed charges,75% of total billed charges for outpatient setting,127.5,83,,102,percent of total billed charges,83% of total billed charges for outpatient setting,76.81,50,,61.448,percent of total billed charges,50% of total billed charges for outpatient setting,76.81,50,,61.448,percent of total billed charges,50% of total billed charges for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.96,127.5,
SHELLFISH PANEL (B),1276722,CDM,300,RC,86003,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,52.29,
SHELLFISH PANEL (B),1276723,CDM,300,RC,86003,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,52.29,
SHELLFISH PANEL (B),1276724,CDM,300,RC,86003,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,52.29,
SHELLFISH PANEL (B),1276725,CDM,300,RC,86003,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,52.29,
TILAPIA IgE,1276727,CDM,300,RC,86003,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,64.74,
STREPTOMYCIN LEVEL,1276728,CDM,300,RC,80299,HCPCS,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,77.19,
MYCOPHENOLIC ACID,1276729,CDM,300,RC,80180,HCPCS,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,18.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.55,44.82,
NK CELLS LCLS (CD57) BLOOD,1276730,CDM,300,RC,86357,HCPCS,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,44.82,
MRSA CULTURE SCREEN,1276731,CDM,300,RC,87081,HCPCS,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,6.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,25.73,
S PNEUMOCOCCAL AB (23 SEROTYPES) (B) #1,1276733,CDM,300,RC,86317,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,62.25,
S PNEUMOCOCCAL AB (23 SEROTYPES) (B) #2,1276734,CDM,300,RC,86317,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,62.25,
HYROXYCORTICOSTEROIDS 17,1278871,CDM,300,RC,83491,HCPCS,outpatient,,,124,62,,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,96.72,78,,77.376,percent of total billed charges,78% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,102.92,83,,82.336,percent of total billed charges,83% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.41,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.41,102.92,
CA 27-29,1278872,CDM,300,RC,86300,HCPCS,outpatient,,,148,74,,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,115.44,78,,92.352,percent of total billed charges,78% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.84,83,,98.272,percent of total billed charges,83% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,122.84,
CITRATE URINE,1278877,CDM,300,RC,82507,HCPCS,outpatient,,,138,69,,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,27.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,107.64,78,,86.112,percent of total billed charges,78% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,96.6,70,,77.28,percent of total billed charges,70% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.5,75,,82.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.54,83,,91.632,percent of total billed charges,83% of total billed charges for outpatient setting,69,50,,55.2,percent of total billed charges,50% of total billed charges for outpatient setting,69,50,,55.2,percent of total billed charges,50% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.48,114.54,
OXALATE (URINE),1278878,CDM,300,RC,83945,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,75.53,
24HR URINE SODIUM,1278879,CDM,300,RC,84300,HCPCS,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,10.79,
24HR URINE PHOSPHORUS,1278880,CDM,300,RC,84105,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,15.77,
24HR URIC ACID,1278881,CDM,300,RC,84560,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,5.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,83,
24 HR URINE UREA,1278882,CDM,300,RC,84540,HCPCS,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,14.11,
M TUBER BY PCR,1278885,CDM,300,RC,87556,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,41.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.65,35,,38.92,percent of total billed charges,35% of total billed charges for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.45,39.17,,43.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,41.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.68,115.37,
E COLI SHIGA-LIKE TOXIN,1278890,CDM,300,RC,87449,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,70.55,
MUMPS VIRUS IMMUNITY,1278895,CDM,300,RC,86735,HCPCS,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.49,77.19,
DRUG SCREEN (CO),1278896,CDM,300,RC,80307,HCPCS,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,64.22,
PTH - RELATED PROTEIN,1278897,CDM,300,RC,83519,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,40.67,
ANTI RNP AB,1278898,CDM,300,RC,86235,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,53.12,
SEPARATION BY DENSITY GRADIENT,1278902,CDM,300,RC,86972,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,146.71,
BB ARC SERVICE FEE,1278903,CDM,300,RC,,,outpatient,,,927,463.5,,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,355.97,38.4,,284.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,355.97,38.4,,284.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,695.25,75,,556.2,percent of total billed charges,75% of total billed charges for outpatient setting,695.25,75,,556.2,percent of total billed charges,75% of total billed charges for outpatient setting,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,695.25,75,,556.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,324.45,35,,259.56,percent of total billed charges,35% of total billed charges for outpatient setting,723.06,78,,578.448,percent of total billed charges,78% of total billed charges for outpatient setting,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,648.9,70,,519.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,695.25,75,,556.2,percent of total billed charges,75% of total billed charges for outpatient setting,769.41,83,,615.528,percent of total billed charges,83% of total billed charges for outpatient setting,463.5,50,,370.8,percent of total billed charges,50% of total billed charges for outpatient setting,463.5,50,,370.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,363.09,39.17,,290.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,324.45,769.41,
BORDATELLA CULTURE,1278905,CDM,300,RC,87081,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.33,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.83,39.84,
ANA (FLOURESCENT),1278906,CDM,300,RC,86039,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,11.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.83,66.4,
COMPLEMENT C1Q,1278908,CDM,300,RC,86160,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,36.52,
LAMONTRIGINE,1278913,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
VIT B 1 THIAMINE PYROPHOSPHATE,1278914,CDM,300,RC,84425,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,21.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.69,63.08,
HERPES SIMPLEX 1 BY PC,1278915,CDM,300,RC,87529,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,58.1,
BASIC PANEL,1278919,CDM,300,RC,80048,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.44,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.46,48.14,
COMPREHENSIVE PANEL,1278920,CDM,300,RC,80053,HCPCS,outpatient,,,133.35,66.68,,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,10.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,100.01,75,,80.008,percent of total billed charges,75% of total billed charges for outpatient setting,100.01,75,,80.008,percent of total billed charges,75% of total billed charges for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,100.01,75,,80.008,percent of total billed charges,75% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.95,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,104.01,78,,83.208,percent of total billed charges,78% of total billed charges for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,93.35,70,,74.68,percent of total billed charges,70% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.01,75,,80.008,percent of total billed charges,75% of total billed charges for outpatient setting,110.68,83,,88.544,percent of total billed charges,83% of total billed charges for outpatient setting,66.68,50,,53.344,percent of total billed charges,50% of total billed charges for outpatient setting,66.68,50,,53.344,percent of total billed charges,50% of total billed charges for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,110.68,
LIVER FUNCTION PANEL,1278921,CDM,300,RC,80076,HCPCS,outpatient,,,24.48,12.24,,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.09,78,,15.272,percent of total billed charges,78% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,83,,16.256,percent of total billed charges,83% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.2,20.32,
RENAL FUNCTION PANEL,1278922,CDM,300,RC,80069,HCPCS,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.92,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,10.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.64,25.73,
FREE PHENYTOIN,1278924,CDM,300,RC,80186,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.12,81.34,
ISLET CELL ANTIBODIES,1278925,CDM,300,RC,86341,HCPCS,outpatient,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,23.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,23.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,116.2,
CRP HS CARDIAC,1278927,CDM,300,RC,86141,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.95,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.95,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
T. PALLIDUM AB-MHA,1278928,CDM,300,RC,86780,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.24,78.02,
INSULIN,1278931,CDM,300,RC,83525,HCPCS,outpatient,,,220.72,110.36,,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,165.54,75,,132.432,percent of total billed charges,75% of total billed charges for outpatient setting,165.54,75,,132.432,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,165.54,75,,132.432,percent of total billed charges,75% of total billed charges for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,172.16,78,,137.728,percent of total billed charges,78% of total billed charges for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,70,,123.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165.54,75,,132.432,percent of total billed charges,75% of total billed charges for outpatient setting,183.2,83,,146.56,percent of total billed charges,83% of total billed charges for outpatient setting,110.36,50,,88.288,percent of total billed charges,50% of total billed charges for outpatient setting,110.36,50,,88.288,percent of total billed charges,50% of total billed charges for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.07,183.2,
HEP C GENOTYPE,1278933,CDM,300,RC,87902,HCPCS,outpatient,,,1032,516,,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,257.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,109.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,774,75,,619.2,percent of total billed charges,75% of total billed charges for outpatient setting,774,75,,619.2,percent of total billed charges,75% of total billed charges for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,774,75,,619.2,percent of total billed charges,75% of total billed charges for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,804.96,78,,643.968,percent of total billed charges,78% of total billed charges for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,722.4,70,,577.92,percent of total billed charges,70% of total billed charges for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,774,75,,619.2,percent of total billed charges,75% of total billed charges for outpatient setting,856.56,83,,685.248,percent of total billed charges,83% of total billed charges for outpatient setting,516,50,,412.8,percent of total billed charges,50% of total billed charges for outpatient setting,516,50,,412.8,percent of total billed charges,50% of total billed charges for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,257.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.77,856.56,
TOPIRAMATE,1278936,CDM,300,RC,80201,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.49,70.55,
PSA SCREENING,1278938,CDM,300,RC,G0103,HCPCS,outpatient,,,36.29,18.15,,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,19.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.31,78,,22.648,percent of total billed charges,78% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,30.12,83,,24.096,percent of total billed charges,83% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.99,30.12,
PLATELET COUNT,1278939,CDM,300,RC,85049,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,4.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,37.35,
ENDOMYSIAL IGA AB,1278940,CDM,300,RC,86256,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,149.4,
THALLIUM - URINE,1279033,CDM,300,RC,83018,HCPCS,outpatient,,,156,78,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,121.68,78,,97.344,percent of total billed charges,78% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,83,,103.584,percent of total billed charges,83% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.33,129.48,
TRYPTASE LEVEL,1279034,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
CTX C TELOPEPTIDE TELOPEPTIDE,1279036,CDM,300,RC,82523,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.45,109.56,
ECTASY,1279037,CDM,300,RC,80301,HCPCS,outpatient,,,110,55,,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.24,38.4,,33.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.5,35,,30.8,percent of total billed charges,35% of total billed charges for outpatient setting,85.8,78,,68.64,percent of total billed charges,78% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,91.3,83,,73.04,percent of total billed charges,83% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.08,39.17,,34.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.5,91.3,
CRYOGLOBULIN,1279039,CDM,300,RC,82595,HCPCS,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,38.18,
GENERAL HEALTH PANEL,1279041,CDM,300,RC,80050,HCPCS,outpatient,,,360,180,,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126,35,,100.8,percent of total billed charges,35% of total billed charges for outpatient setting,280.8,78,,224.64,percent of total billed charges,78% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,298.8,83,,239.04,percent of total billed charges,83% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141,39.17,,112.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,126,298.8,
LYSOZYME,1279042,CDM,300,RC,85549,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.51,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.51,110.39,
SINEMET (LEVODOPA/CARIDOPA),1279043,CDM,300,RC,80299,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,68.89,
STOOL CULT EA ADD ORG,1279044,CDM,300,RC,87046,HCPCS,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.08,87.98,
BETA LACTAMASE,1279045,CDM,300,RC,87185,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
HCG URINE,1279046,CDM,300,RC,81025,HCPCS,outpatient,,,187.6,93.8,,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,146.33,78,,117.064,percent of total billed charges,78% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,131.32,70,,105.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.7,75,,112.56,percent of total billed charges,75% of total billed charges for outpatient setting,155.71,83,,124.568,percent of total billed charges,83% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,93.8,50,,75.04,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.57,155.71,
DRUG SCREEN (CO) 40.00,1279047,CDM,300,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
EOSINOPHIL COUNT BLOOD,1279048,CDM,300,RC,85048,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.24,14.94,
COLLECTION FEE - DRUG SCREEN,1279049,CDM,300,RC,36415,HCPCS,outpatient,,,21.94,10.97,,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,8.83,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,38.4,,6.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.42,38.4,,6.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.68,35,,6.144,percent of total billed charges,35% of total billed charges for outpatient setting,17.11,78,,13.688,percent of total billed charges,78% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,18.21,83,,14.568,percent of total billed charges,83% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.59,39.17,,6.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.68,18.21,
PROGRAPH,1279051,CDM,300,RC,80197,HCPCS,outpatient,,,41.36,20.68,,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,13.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.11,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.26,78,,25.808,percent of total billed charges,78% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,34.33,83,,27.464,percent of total billed charges,83% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.08,34.33,
SERUM VISCOSITY,1279052,CDM,300,RC,85810,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.67,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.67,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.28,68.89,
OSTEOCALCIN,1279053,CDM,300,RC,83937,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,29.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.54,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.28,175.13,
WEST NILE VIRUS IGM SERUM,1279054,CDM,300,RC,86788,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.83,138.61,
HCG TUMOR MARKER,1279055,CDM,300,RC,84702,HCPCS,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.65,38.18,
VENIPUNCTURE,1279056,CDM,300,RC,36415,HCPCS,outpatient,,,18.57,9.29,,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,8.83,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.13,38.4,,5.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.13,38.4,,5.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.93,75,,11.144,percent of total billed charges,75% of total billed charges for outpatient setting,13.93,75,,11.144,percent of total billed charges,75% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.93,75,,11.144,percent of total billed charges,75% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.5,35,,5.2,percent of total billed charges,35% of total billed charges for outpatient setting,14.48,78,,11.584,percent of total billed charges,78% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,13,70,,10.4,percent of total billed charges,70% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.93,75,,11.144,percent of total billed charges,75% of total billed charges for outpatient setting,15.41,83,,12.328,percent of total billed charges,83% of total billed charges for outpatient setting,9.29,50,,7.432,percent of total billed charges,50% of total billed charges for outpatient setting,9.29,50,,7.432,percent of total billed charges,50% of total billed charges for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.27,39.17,,5.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,8.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.5,15.41,
ANTI NEURNONAL AB PANEL,1279057,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
SSA AB,1279060,CDM,300,RC,86235,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,105.41,
SMITH AB,1279061,CDM,300,RC,86235,HCPCS,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,53.12,
"HISTAMINE, URINE",1279062,CDM,300,RC,83088,HCPCS,outpatient,,,209,104.5,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,29.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,163.02,78,,130.416,percent of total billed charges,78% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,173.47,83,,138.776,percent of total billed charges,83% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.99,173.47,
HGB A2 QUANT,1279063,CDM,300,RC,82486,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
FACTOR V LEIDEN BY PCR,1279065,CDM,300,RC,81241,HCPCS,outpatient,,,217,108.5,,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,73.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,162.75,75,,130.2,percent of total billed charges,75% of total billed charges for outpatient setting,162.75,75,,130.2,percent of total billed charges,75% of total billed charges for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,162.75,75,,130.2,percent of total billed charges,75% of total billed charges for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,169.26,78,,135.408,percent of total billed charges,78% of total billed charges for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,151.9,70,,121.52,percent of total billed charges,70% of total billed charges for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162.75,75,,130.2,percent of total billed charges,75% of total billed charges for outpatient setting,180.11,83,,144.088,percent of total billed charges,83% of total billed charges for outpatient setting,108.5,50,,86.8,percent of total billed charges,50% of total billed charges for outpatient setting,108.5,50,,86.8,percent of total billed charges,50% of total billed charges for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,73.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,180.11,
LEGIONELLA SP BY PCR,1279067,CDM,300,RC,87541,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,115.37,
M PNEUMONIAE BY PCR,1279068,CDM,300,RC,87581,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,115.37,
SAP 10 CO,1279072,CDM,300,RC,80307,HCPCS,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,158.53,
NITRO BLUE TETRAZOLIUM,1279073,CDM,300,RC,86384,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,13.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.02,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.02,67.23,
DHEAS,1279075,CDM,300,RC,82627,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,22.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.96,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.57,92.13,
THY PEROXIDASE ANTIBODY,1279076,CDM,300,RC,86376,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,43.16,
24HR CYSTINE URINE,1279078,CDM,300,RC,82131,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,22.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
SCHISTOSOMA TITER,1279079,CDM,300,RC,86682,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.45,76.36,
LEPTOSPIRA AB,1279080,CDM,300,RC,86720,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
BNP,1279081,CDM,300,RC,83880,HCPCS,outpatient,,,102.12,51.06,,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,79.65,78,,63.72,percent of total billed charges,78% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,71.48,70,,57.184,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.59,75,,61.272,percent of total billed charges,75% of total billed charges for outpatient setting,84.76,83,,67.808,percent of total billed charges,83% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,51.06,50,,40.848,percent of total billed charges,50% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,84.76,
METHANOL LEVEL,1279082,CDM,300,RC,84600,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,17.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.15,95.45,
PT G20210 MUTATION,1279083,CDM,300,RC,81240,HCPCS,outpatient,,,174,87,,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,65.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,135.72,78,,108.576,percent of total billed charges,78% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,144.42,83,,115.536,percent of total billed charges,83% of total billed charges for outpatient setting,87,50,,69.6,percent of total billed charges,50% of total billed charges for outpatient setting,87,50,,69.6,percent of total billed charges,50% of total billed charges for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,65.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,144.42,
TISSUE TRANSGLUTIMASE AB,1279084,CDM,300,RC,83516,HCPCS,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,131.14,
SOLUBLE TRANSFERRIN RECEPTOR,1279085,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
ESTRIOL,1279086,CDM,300,RC,82677,HCPCS,outpatient,,,171,85.5,,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,24.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,30.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,133.38,78,,106.704,percent of total billed charges,78% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,141.93,83,,113.544,percent of total billed charges,83% of total billed charges for outpatient setting,85.5,50,,68.4,percent of total billed charges,50% of total billed charges for outpatient setting,85.5,50,,68.4,percent of total billed charges,50% of total billed charges for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.29,141.93,
"FACTOR VIII, BETHESDA QUANT",1279087,CDM,300,RC,85335,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,75.53,
FACTOR VIII C,1279088,CDM,300,RC,85240,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,63.5,50,,50.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,105.41,
PSA FREE,1279089,CDM,300,RC,84154,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,53.95,
WEST NILE VIRUS IGG,1279090,CDM,300,RC,86789,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,96.28,
EASTERN EQUINE ENCEPHALITIS IG,1279091,CDM,300,RC,86652,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
ST LOUIS EQUINE ENCEPHALITIS I,1279092,CDM,300,RC,86653,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
CALIFORNIA EQUINE ENCEPHALITIS,1279093,CDM,300,RC,86651,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
WESTERN EQUINE ENCEPHALITIS IG,1279094,CDM,300,RC,86654,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
HIGH RISK SCREEN FOR SIDS,1279095,CDM,300,RC,83788,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
VASOPRESSIN HORMONE,1279096,CDM,300,RC,84588,HCPCS,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,33.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,199.2,
NOREPINEPHRINE LEVEL,1279097,CDM,300,RC,82384,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,149.4,
T3 TOTAL,1279098,CDM,300,RC,84480,HCPCS,outpatient,,,64.4,32.2,,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.23,78,,40.184,percent of total billed charges,78% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,53.45,83,,42.76,percent of total billed charges,83% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.22,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.22,53.45,
FECAL ELASTASE,1279100,CDM,300,RC,83519,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,40.67,
N-TELOPEPTIDE CROSS LINKED URI,1279101,CDM,300,RC,82523,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.45,109.56,
VITAMIN D 25 HYDROXY,1279102,CDM,300,RC,82306,HCPCS,outpatient,,,88.62,44.31,,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,29.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,66.47,75,,53.176,percent of total billed charges,75% of total billed charges for outpatient setting,66.47,75,,53.176,percent of total billed charges,75% of total billed charges for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,66.47,75,,53.176,percent of total billed charges,75% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.08,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.12,78,,55.296,percent of total billed charges,78% of total billed charges for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,62.03,70,,49.624,percent of total billed charges,70% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.47,75,,53.176,percent of total billed charges,75% of total billed charges for outpatient setting,73.55,83,,58.84,percent of total billed charges,83% of total billed charges for outpatient setting,44.31,50,,35.448,percent of total billed charges,50% of total billed charges for outpatient setting,44.31,50,,35.448,percent of total billed charges,50% of total billed charges for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.05,73.55,
"PSEUDOCHOLINESTERASE, DIBUCAIN",1279104,CDM,300,RC,82638,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.78,72.21,
GIARDIA ANTIBODY,1279108,CDM,300,RC,86674,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.95,86.32,
CMV BY PCR,1279110,CDM,300,RC,87496,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,115.37,
VDRL CSF,1279111,CDM,300,RC,86592,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.26,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.26,52.29,
NEUROMETABOLIC SCR URINE,1279113,CDM,300,RC,82128,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.3,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.2,81.34,
ENTEROVIRUS BY PCR,1279116,CDM,300,RC,87798,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,115.37,
FECAL FAT QUANT,1279118,CDM,300,RC,82710,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.78,49.8,
MYCOPLASMA AND UREAPLASMA,1279119,CDM,300,RC,87109,HCPCS,outpatient,,,110,55,,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,15.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.8,78,,68.64,percent of total billed charges,78% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,91.3,83,,73.04,percent of total billed charges,83% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.55,91.3,
SEX HORMONE BINDING GLOBULIN,1279121,CDM,300,RC,84270,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,21.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.32,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.12,64.74,
ARGININE VASOPRESSIN HORMONE,1279122,CDM,300,RC,84588,HCPCS,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,33.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,33.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,199.2,
KEPPRA LEVEL,1279123,CDM,300,RC,80299,HCPCS,outpatient,,,37.14,18.57,,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,27.86,75,,22.288,percent of total billed charges,75% of total billed charges for outpatient setting,27.86,75,,22.288,percent of total billed charges,75% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,27.86,75,,22.288,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.97,78,,23.176,percent of total billed charges,78% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.86,75,,22.288,percent of total billed charges,75% of total billed charges for outpatient setting,30.83,83,,24.664,percent of total billed charges,83% of total billed charges for outpatient setting,18.57,50,,14.856,percent of total billed charges,50% of total billed charges for outpatient setting,18.57,50,,14.856,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,30.83,
CHARGE FOR URINE W/MICRO,1279129,CDM,300,RC,81001,HCPCS,outpatient,,,56.55,28.28,,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,3.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,44.11,78,,35.288,percent of total billed charges,78% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,39.59,70,,31.672,percent of total billed charges,70% of total billed charges for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.41,75,,33.928,percent of total billed charges,75% of total billed charges for outpatient setting,46.94,83,,37.552,percent of total billed charges,83% of total billed charges for outpatient setting,28.28,50,,22.624,percent of total billed charges,50% of total billed charges for outpatient setting,28.28,50,,22.624,percent of total billed charges,50% of total billed charges for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.79,46.94,
HTLV I AND II,1279131,CDM,300,RC,86687,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,9.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.09,49.8,
THROAT CULTURE(B),1279132,CDM,300,RC,87070,HCPCS,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.58,123.67,
"THIAZIDE, URINE",1279133,CDM,300,RC,82491,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
BICARBONATE URINE,1279134,CDM,300,RC,82374,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,28.22,
HIV 1 RNA QUANT PCR,1279136,CDM,300,RC,87536,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,85.1,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,56.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,85.1,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,153.55,
"HHV 6 AB, IGG",1279137,CDM,300,RC,86790,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,76.36,
CSF CELL CT WITH DIFF,1279139,CDM,300,RC,89051,HCPCS,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.55,8.3,
CSF GLUCOSE,1279140,CDM,300,RC,82945,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.45,68.89,
CSF PROTEIN,1279141,CDM,300,RC,84160,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,21.58,
CSF CHLORIDE,1279142,CDM,300,RC,82438,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.15,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.31,29.05,
MYELIN BASIC PROTEIN,1279144,CDM,300,RC,83873,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.64,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.64,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,61,50,,48.8,percent of total billed charges,50% of total billed charges for outpatient setting,61,50,,48.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.15,101.26,
ANTI DNASE,1279145,CDM,300,RC,86215,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.66,78.02,
SEROTONIN SERUM,1279147,CDM,300,RC,84260,HCPCS,outpatient,,,220,110,,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,30.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,38.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,171.6,78,,137.28,percent of total billed charges,78% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,182.6,83,,146.08,percent of total billed charges,83% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,30.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.27,182.6,
ANTICYCLIC CITRULLINATED PEPTI,1279148,CDM,300,RC,83516,HCPCS,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,152.72,
VANC SCREEN FOR STAPH AUREUS,1279149,CDM,300,RC,87187,HCPCS,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,40.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,40.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.12,58.93,
CMV DNA QUANT PCR,1279152,CDM,300,RC,87497,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,126.16,
CRYPTOCOCCUS AB,1279154,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
24HR ALUMINUM URINE,1279155,CDM,300,RC,82108,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.84,99.6,
HEP B RTPCR QUANT,1279156,CDM,300,RC,87517,HCPCS,outpatient,,,303,151.5,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,236.34,78,,189.072,percent of total billed charges,78% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,251.49,83,,201.192,percent of total billed charges,83% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.71,251.49,
IBUPROFEN LEVEL,1279159,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
STRIATED MUSCLE,1279160,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
HSV TYPE 2 GLYCOPROTEIN G SPEC,1279161,CDM,300,RC,86696,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,113.71,
FELBRAMATE,1279162,CDM,300,RC,82491,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.6,96.28,
OXCARBAZEPINE METABOLITE,1279163,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
ZONISAMIDE,1279164,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
H PYLORI AG,1279165,CDM,300,RC,87338,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.66,43.16,
C1 ESTERASE,1279166,CDM,300,RC,86160,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,36.52,
SULFONUREA URINE,1279167,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
BORDATELLA IGG,1279168,CDM,300,RC,86615,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
PYRUVATE,1279169,CDM,300,RC,84210,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.56,64.74,
"TESTOSTERONE, BIOAVAILABLE",1279170,CDM,300,RC,84403,HCPCS,outpatient,,,183,91.5,,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,142.74,78,,114.192,percent of total billed charges,78% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,151.89,83,,121.512,percent of total billed charges,83% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.73,151.89,
LIVER-KIDNEY MICROSOMAL AB  LK,1279171,CDM,300,RC,86376,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.81,85.49,
TPMT RBC,1279172,CDM,300,RC,83789,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,35.69,
LISTERIA AB (CSF),1279173,CDM,300,RC,86723,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,78.02,
GDL DRUG SCREEN,1279174,CDM,300,RC,80301,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
GAD AB,1279175,CDM,300,RC,83519,HCPCS,outpatient,,,41.36,20.68,,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.26,78,,25.808,percent of total billed charges,78% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,28.95,70,,23.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.02,75,,24.816,percent of total billed charges,75% of total billed charges for outpatient setting,34.33,83,,27.464,percent of total billed charges,83% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,20.68,50,,16.544,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,34.33,
VIT E,1279176,CDM,300,RC,84446,HCPCS,outpatient,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.48,42.33,
ACYLCARNITINE QUANT PROFILE,1279180,CDM,300,RC,82017,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
BIOTINIDASE,1279181,CDM,300,RC,82261,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,99.6,
MYOGLOBIN SERUM,1279182,CDM,300,RC,83874,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.37,76.36,
NMR LIPOPROFILE,1279184,CDM,300,RC,83704,HCPCS,outpatient,,,224,112,,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,39.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,174.72,78,,139.776,percent of total billed charges,78% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,185.92,83,,148.736,percent of total billed charges,83% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.77,185.92,
STREP PNEU AG URINE,1279185,CDM,300,RC,87899,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,70.55,
FETOMATERNAL BLEED,1279186,CDM,300,RC,86356,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.98,153.55,
COLLAGEN TYPE I C-TELOPEPTIDE,1279187,CDM,300,RC,82397,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.44,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.44,83,
HFE HEMOCHROMATIOSIS DNA MUTAT,1279190,CDM,300,RC,81256,HCPCS,outpatient,,,232,116,,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,65.36,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,180.96,78,,144.768,percent of total billed charges,78% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.56,83,,154.048,percent of total billed charges,83% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,65.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,192.56,
HEPATITIS BE ANTIGEN,1279193,CDM,300,RC,87350,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.14,34.86,
BK VIRUS DNA BY PCR,1279195,CDM,300,RC,87799,HCPCS,outpatient,,,303,151.5,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.05,35,,84.84,percent of total billed charges,35% of total billed charges for outpatient setting,236.34,78,,189.072,percent of total billed charges,78% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,251.49,83,,201.192,percent of total billed charges,83% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.68,39.17,,94.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,251.49,
PREGABALIN,1279196,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
"FUNGUS C&S SKIN,HAIR,NAIL(B)",1279201,CDM,300,RC,87101,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.78,22.41,
FUNGUS SMEAR W FLUORESCENT KOH,1279202,CDM,300,RC,87206,HCPCS,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,16.6,
"ADENOVIRUS, DFA",1279203,CDM,300,RC,87260,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,14.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,70.55,
ADENOVIRUS AG GASTROENTERITIS,1279204,CDM,300,RC,87301,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,70.55,
ALPHA-1-ANTITRYPSIN (AAT) GENO,1279206,CDM,300,RC,83891,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
ALPHA-1-ANTITRYPSIN (AAT) GENO,1279207,CDM,300,RC,83892,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
ALPHA-1-ANTITRYPSIN (AAT) GENO,1279208,CDM,300,RC,83900,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
ALPHA-1-ANTITRYPSIN (AAT) GENO,1279209,CDM,300,RC,83909,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
ALPHA-1-ANTITRYPSIN (AAT) GENO,1279210,CDM,300,RC,83912,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
"MRSA, PCR",1279211,CDM,300,RC,87641,HCPCS,outpatient,,,117.32,58.66,,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,87.99,75,,70.392,percent of total billed charges,75% of total billed charges for outpatient setting,87.99,75,,70.392,percent of total billed charges,75% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,87.99,75,,70.392,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,91.51,78,,73.208,percent of total billed charges,78% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.99,75,,70.392,percent of total billed charges,75% of total billed charges for outpatient setting,97.38,83,,77.904,percent of total billed charges,83% of total billed charges for outpatient setting,58.66,50,,46.928,percent of total billed charges,50% of total billed charges for outpatient setting,58.66,50,,46.928,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,97.38,
CRYTOSPORIDIUM AG BY EIA (B),1279212,CDM,300,RC,87015,HCPCS,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.88,38.18,
CRYTOSPORIDIUM AG BY EIA (B),1279213,CDM,300,RC,87272,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,68.06,
RETICULIN AB IGA W/ REFLEX,1279214,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
RETICULIN AB IGG,1279215,CDM,300,RC,86255,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,71.38,
BETA 2 GLYCOPROTEIN IGA,1279216,CDM,300,RC,86146,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.39,75.53,
HEAVY METALS URINE (B),1279217,CDM,300,RC,82570,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,14.94,
ALDOSTERONE/RENIN RATIO (B),1279219,CDM,300,RC,82088,HCPCS,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,40.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.88,291.33,
ALDOSTERONE/RENIN RATIO (B),1279220,CDM,300,RC,84244,HCPCS,outpatient,,,209,104.5,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.66,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,163.02,78,,130.416,percent of total billed charges,78% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,173.47,83,,138.776,percent of total billed charges,83% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.36,173.47,
CHROMOGRANIN A,1279222,CDM,300,RC,86316,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.31,62.25,
SULFONYLUREA SERUM,1279223,CDM,300,RC,80301,HCPCS,outpatient,,,232,116,,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.2,35,,64.96,percent of total billed charges,35% of total billed charges for outpatient setting,180.96,78,,144.768,percent of total billed charges,78% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.56,83,,154.048,percent of total billed charges,83% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.87,39.17,,72.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.2,192.56,
"KAPPA/LAMBDA LIGHT CHAINS,FREE",1279227,CDM,300,RC,83883,HCPCS,outpatient,,,39.67,19.84,,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,13.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.94,78,,24.752,percent of total billed charges,78% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,27.77,70,,22.216,percent of total billed charges,70% of total billed charges for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,75,,23.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.93,83,,26.344,percent of total billed charges,83% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,19.84,50,,15.872,percent of total billed charges,50% of total billed charges for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.97,32.93,
BORD PERTUSSIS-DFA (B),1279228,CDM,300,RC,87265,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,68.06,
HEP B SURFACE AB QUANT,1279229,CDM,300,RC,86706,HCPCS,outpatient,,,64.99,32.5,,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,48.74,75,,38.992,percent of total billed charges,75% of total billed charges for outpatient setting,48.74,75,,38.992,percent of total billed charges,75% of total billed charges for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,48.74,75,,38.992,percent of total billed charges,75% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.69,78,,40.552,percent of total billed charges,78% of total billed charges for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,45.49,70,,36.392,percent of total billed charges,70% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.74,75,,38.992,percent of total billed charges,75% of total billed charges for outpatient setting,53.94,83,,43.152,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.46,53.94,
"CHLAMYDIA/GC DNA, SDA (B)",1279232,CDM,300,RC,87491,HCPCS,outpatient,,,95.2,47.6,,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.26,78,,59.408,percent of total billed charges,78% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,79.02,83,,63.216,percent of total billed charges,83% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,79.02,
"CHLAMYDIA/GC DNA, SDA (B)",1279233,CDM,300,RC,87591,HCPCS,outpatient,,,95.2,47.6,,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.26,78,,59.408,percent of total billed charges,78% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,79.02,83,,63.216,percent of total billed charges,83% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,79.02,
ANA CASCADING REFLEX (B),1279235,CDM,300,RC,86038,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,68.89,
ANA CASCADING REFLEX (B),1279236,CDM,300,RC,86225,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.1,78.02,
ANA CASCADING REFLEX (B),1279237,CDM,300,RC,86235,HCPCS,outpatient,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.93,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.79,102.09,
ANA CASCADING REFLEX (B),1279238,CDM,300,RC,83520,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,73.87,
ANA CASCADING REFLEX (B),1279239,CDM,300,RC,86038,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.64,68.89,
H PYLORI IGA AB,1279240,CDM,300,RC,86677,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.85,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.78,85.49,
SCABIES,1279242,CDM,300,RC,87220,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.36,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.75,24.9,
CORTISOL FREE,1279243,CDM,300,RC,82530,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,49.8,
METHYLMALONIC AND HOMOCYSTINE(,1279244,CDM,300,RC,83090,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,17.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.85,49.8,
METHYLMALONIC AND HOMOCYSTINE(,1279245,CDM,300,RC,83921,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,48.97,
MERCURY 24HR URINE,1279246,CDM,300,RC,83825,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.32,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.32,96.28,
LEAD 24HR URINE,1279247,CDM,300,RC,83655,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7,71.38,
24HR ARSENIC  URINE,1279248,CDM,300,RC,82175,HCPCS,outpatient,,,134,67,,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.86,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,104.52,78,,83.616,percent of total billed charges,78% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.22,83,,88.976,percent of total billed charges,83% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.7,111.22,
METANEPHRINES PLASMA,1279249,CDM,300,RC,83835,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.37,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.91,99.6,
HSV 1&2 IGG CSF (B),1279251,CDM,300,RC,87529,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,56.44,
CATECHOLAMINES PLASMA,1279252,CDM,300,RC,82384,HCPCS,outpatient,,,296,148,,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,222,75,,177.6,percent of total billed charges,75% of total billed charges for outpatient setting,222,75,,177.6,percent of total billed charges,75% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,222,75,,177.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,230.88,78,,184.704,percent of total billed charges,78% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,222,75,,177.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.68,83,,196.544,percent of total billed charges,83% of total billed charges for outpatient setting,148,50,,118.4,percent of total billed charges,50% of total billed charges for outpatient setting,148,50,,118.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.23,245.68,
ACETHYLCHOL RECEP BLOCKING AB,1279253,CDM,300,RC,83519,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,79.68,
CHARGE CBC W/O DIFF,1279254,CDM,300,RC,85027,HCPCS,outpatient,,,124,62,,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,96.72,78,,77.376,percent of total billed charges,78% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,102.92,83,,82.336,percent of total billed charges,83% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.7,102.92,
THROMBIN CLOTTING TIME,1279255,CDM,300,RC,85670,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.26,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.62,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.08,34.86,
VIP VASOACTIVE INTESTINAL POLY,1279256,CDM,300,RC,84586,HCPCS,outpatient,,,251,125.5,,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.33,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,188.25,75,,150.6,percent of total billed charges,75% of total billed charges for outpatient setting,188.25,75,,150.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,188.25,75,,150.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,195.78,78,,156.624,percent of total billed charges,78% of total billed charges for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,175.7,70,,140.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.25,75,,150.6,percent of total billed charges,75% of total billed charges for outpatient setting,208.33,83,,166.664,percent of total billed charges,83% of total billed charges for outpatient setting,125.5,50,,100.4,percent of total billed charges,50% of total billed charges for outpatient setting,125.5,50,,100.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.33,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,208.33,
APC RESISTANCE,1279257,CDM,300,RC,85307,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,15.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.49,90.47,
LEFLUNOMIDE,1279258,CDM,300,RC,80299,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,36.52,
PAROXETINE(PAXIL),1279259,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
"LYME CSF DNA,PCR",1279261,CDM,300,RC,87476,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,58.1,
"HISTOPLASMA AB, IMMUNODIFFUSIO",1279262,CDM,300,RC,86698,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,73.87,
HIV P24 AG,1279263,CDM,300,RC,87390,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,24.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.48,52.29,
"VARICELLA ZOSTER DNA,PCR",1279264,CDM,300,RC,87798,HCPCS,outpatient,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,24.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,115.37,
"VITAMIN D 1,25 DIHYDROXY",1279265,CDM,300,RC,82652,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,48.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,38.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.88,113.71,
DIRECT LDL,1279266,CDM,300,RC,83721,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,10.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.4,28.22,
METHYLMALONIC ACID,1279267,CDM,300,RC,83921,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.7,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.49,48.97,
PLASMINOGEN ACTIVITY,1279269,CDM,300,RC,85420,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.75,39.01,
IGA TISSUE TRANSGLUTAMINASE,1279271,CDM,300,RC,83516,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,63.08,
GASTRIC OCCULT BLOOD,1279272,CDM,300,RC,82271,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,5.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,5.32,
GASTRIC OCCULT BLOOD (B),1279273,CDM,300,RC,82271,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.32,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,19.09,
UROPORPHYRINOGEN DECARBOXYLASE,1279274,CDM,300,RC,82657,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,22.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,22.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,35.69,
IGD,1279276,CDM,300,RC,82784,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.27,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,9.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.18,27.39,
FUNGUS CULTURE BLOOD,1279277,CDM,300,RC,87103,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,20.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.34,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.94,26.56,
SAP 10 DRUG SCREEN PAIN MANAGEMENT,1279278,CDM,300,RC,80307,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,64.22,
SAP 10 DRUG SCREEN CO,1279279,CDM,300,RC,80307,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,64.22,
SAP 6 DRUG SCREEN COMPANY,1279280,CDM,300,RC,80307,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,64.22,
SAP 10 DRUG SCREEN EMPLOYEE,1279281,CDM,300,RC,80307,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,64.22,
TRICHOMONAS VAGINALIS,1279283,CDM,300,RC,87661,HCPCS,outpatient,,,95.2,47.6,,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.26,78,,59.408,percent of total billed charges,78% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,79.02,83,,63.216,percent of total billed charges,83% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,35.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.99,79.02,
MAGNESIUM RBC,1279284,CDM,300,RC,83735,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,19.09,
NT PRO-BNP,1279285,CDM,300,RC,83880,HCPCS,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,39.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,100.43,
CHARGE FOR CBC W/DIFF,1290195,CDM,300,RC,85025,HCPCS,outpatient,,,117.32,58.66,,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,91.51,78,,73.208,percent of total billed charges,78% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,82.12,70,,65.696,percent of total billed charges,70% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.99,75,,70.392,percent of total billed charges,75% of total billed charges for outpatient setting,97.38,83,,77.904,percent of total billed charges,83% of total billed charges for outpatient setting,58.66,50,,46.928,percent of total billed charges,50% of total billed charges for outpatient setting,58.66,50,,46.928,percent of total billed charges,50% of total billed charges for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,97.38,
APOLIPOPROTEIN B,1292413,CDM,300,RC,82172,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,21.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.64,92.13,
AB ID/EA SELECTED REAGENT CELL,1292415,CDM,300,RC,86885,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,146.71,
ANTIMULLERIAN HORMONE,1292416,CDM,300,RC,83516,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,63.08,
GM1 IGM AB,1292417,CDM,300,RC,83520,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,76.36,
CHROMIUM,1292418,CDM,300,RC,82495,HCPCS,outpatient,,,144,72,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,20.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,112.32,78,,89.856,percent of total billed charges,78% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.52,83,,95.616,percent of total billed charges,83% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,72,50,,57.6,percent of total billed charges,50% of total billed charges for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.86,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.86,119.52,
CREATININE URINE,1292420,CDM,300,RC,82570,HCPCS,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,18.26,
FACTOR X,1292423,CDM,300,RC,85260,HCPCS,outpatient,,,266,133,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.52,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,207.48,78,,165.984,percent of total billed charges,78% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,220.78,83,,176.624,percent of total billed charges,83% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.89,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.76,220.78,
CORTISOL SALIVA,1292424,CDM,300,RC,82530,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.71,49.8,
COLOVANTAGE(B),1292426,CDM,300,RC,83891,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
COLOVANTAGE(B),1292427,CDM,300,RC,83896,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
COLOVANTAGE(B),1292428,CDM,300,RC,83898,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
COLOVANTAGE(B),1292429,CDM,300,RC,83912,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
CHARGE FOR UA W/O MICRO,1292430,CDM,300,RC,81003,HCPCS,outpatient,,,37.14,18.57,,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.83,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.97,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.97,78,,23.176,percent of total billed charges,78% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,26,70,,20.8,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.86,75,,22.288,percent of total billed charges,75% of total billed charges for outpatient setting,30.83,83,,24.664,percent of total billed charges,83% of total billed charges for outpatient setting,18.57,50,,14.856,percent of total billed charges,50% of total billed charges for outpatient setting,18.57,50,,14.856,percent of total billed charges,50% of total billed charges for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,2.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.98,30.83,
ALUMINUM SERUM,1292431,CDM,300,RC,82108,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.26,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.84,49.8,
PROTEIN C ANTIGEN,1292432,CDM,300,RC,85302,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.58,99.6,
PROTEIN S ANTIGEN,1292433,CDM,300,RC,85305,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.31,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.21,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.21,96.28,
NEUROKININ A (SUBSTANCE K),1292434,CDM,300,RC,83519,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,79.68,
PANCREASTATIN,1292435,CDM,300,RC,83519,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,79.68,
ANTI-IGE RECEPTOR ANTIBODY (B),1292437,CDM,300,RC,88184,HCPCS,outpatient,,,183,91.5,,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,142.74,78,,114.192,percent of total billed charges,78% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,151.89,83,,121.512,percent of total billed charges,83% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.27,308.75,
ANTI-IGE RECEPTOR ANTIBODY (B),1292438,CDM,300,RC,88185,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.87,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.87,83,
24HR MICROALBUMIN URINE,1292439,CDM,300,RC,82043,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.1,34.86,
LEPTIN,1292440,CDM,300,RC,82397,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.77,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.44,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.44,83,
COBALT,1292441,CDM,300,RC,,,outpatient,,,134,67,,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.46,38.4,,41.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.46,38.4,,41.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.9,35,,37.52,percent of total billed charges,35% of total billed charges for outpatient setting,104.52,78,,83.616,percent of total billed charges,78% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.22,83,,88.976,percent of total billed charges,83% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.49,39.17,,41.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.9,111.22,
PAIN MANAGEMENT BASE PROFILE,1292449,CDM,300,RC,80307,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,64.22,
PH BODY FLUID,1292453,CDM,300,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
24HR URINE UREA 24HR,1292454,CDM,300,RC,84540,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,28.22,
UR K 24 HR (B),1292456,CDM,300,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
ANTIPROTHROMBIN (B),1292458,CDM,300,RC,0030T,HCPCS,outpatient,,,200,100,,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70,35,,56,percent of total billed charges,35% of total billed charges for outpatient setting,156,78,,124.8,percent of total billed charges,78% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,166,83,,132.8,percent of total billed charges,83% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.34,39.17,,62.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70,166,
24HR POTASSIUM URINE,1292459,CDM,300,RC,84132,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.05,43.16,
BCR/ABL QUANT PCR (B),1292462,CDM,300,RC,81206,HCPCS,outpatient,,,562,281,,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,163.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,421.5,75,,337.2,percent of total billed charges,75% of total billed charges for outpatient setting,421.5,75,,337.2,percent of total billed charges,75% of total billed charges for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,421.5,75,,337.2,percent of total billed charges,75% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,438.36,78,,350.688,percent of total billed charges,78% of total billed charges for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,393.4,70,,314.72,percent of total billed charges,70% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,421.5,75,,337.2,percent of total billed charges,75% of total billed charges for outpatient setting,466.46,83,,373.168,percent of total billed charges,83% of total billed charges for outpatient setting,281,50,,224.8,percent of total billed charges,50% of total billed charges for outpatient setting,281,50,,224.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,466.46,
"BCR/ABL, QUANT PCR (B)",1292463,CDM,300,RC,81206,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,163.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,163.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20,163.96,
"BCR/ABL, QUANT PCR (B)",1292464,CDM,300,RC,81220,HCPCS,outpatient,,,200,100,,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,556.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,960,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,960,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1008,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,156,78,,124.8,percent of total billed charges,78% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,166,83,,132.8,percent of total billed charges,83% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,672,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,556.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100,1008,
"BCR/ABL, QUANT PCR (B)",1292465,CDM,300,RC,81207,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,144.84,
"BCR/ABL, QUANT PCR (B)",1292466,CDM,300,RC,81207,HCPCS,outpatient,,,497,248.5,,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,98.4,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,372.75,75,,298.2,percent of total billed charges,75% of total billed charges for outpatient setting,372.75,75,,298.2,percent of total billed charges,75% of total billed charges for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,372.75,75,,298.2,percent of total billed charges,75% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,387.66,78,,310.128,percent of total billed charges,78% of total billed charges for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,347.9,70,,278.32,percent of total billed charges,70% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,372.75,75,,298.2,percent of total billed charges,75% of total billed charges for outpatient setting,412.51,83,,330.008,percent of total billed charges,83% of total billed charges for outpatient setting,248.5,50,,198.8,percent of total billed charges,50% of total billed charges for outpatient setting,248.5,50,,198.8,percent of total billed charges,50% of total billed charges for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,144.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.88,412.51,
"ALCOHOL, ISOPROPYL, BLOOD",1292467,CDM,300,RC,84600,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,17.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,57.5,50,,46,percent of total billed charges,50% of total billed charges for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.15,95.45,
CYSTATIN C,1292468,CDM,300,RC,82610,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.52,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.96,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.97,79.68,
ETHYL GLUCURONIDE,1292469,CDM,300,RC,80302,HCPCS,outpatient,,,124,62,,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.4,35,,34.72,percent of total billed charges,35% of total billed charges for outpatient setting,96.72,78,,77.376,percent of total billed charges,78% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,102.92,83,,82.336,percent of total billed charges,83% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.57,39.17,,38.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.4,102.92,
"ESTRADIOL, ULTRASENSITIVE",1292470,CDM,300,RC,82670,HCPCS,outpatient,,,198,99,,138.6,70,,110.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,154.44,78,,123.552,percent of total billed charges,78% of total billed charges for outpatient setting,138.6,70,,110.88,percent of total billed charges,70% of total billed charges for outpatient setting,138.6,70,,110.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,148.5,75,,118.8,percent of total billed charges,75% of total billed charges for outpatient setting,164.34,83,,131.472,percent of total billed charges,83% of total billed charges for outpatient setting,99,50,,79.2,percent of total billed charges,50% of total billed charges for outpatient setting,99,50,,79.2,percent of total billed charges,50% of total billed charges for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.6,164.34,
FUNGAL PANEL 3 ID (B),1292472,CDM,300,RC,86612,HCPCS,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.9,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.36,76.36,
FUNGAL PANEL 3 ID (B),1292473,CDM,300,RC,86628,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,71.38,
FUNGAL PANEL 3 ID (B),1292474,CDM,300,RC,86635,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.1,68.06,
FUNGAL PANEL 3 ID (B),1292475,CDM,300,RC,86698,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11,73.87,
HYPER PNEUMONITIS SCREEN (B),1292477,CDM,300,RC,86609,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.01,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.34,52.29,
HYPER PNEUMONITIS SCREEN (B),1292478,CDM,300,RC,86331,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,48.14,
FUNGAL PANEL 3 ID (B),1292479,CDM,300,RC,86606,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,89.64,
HYPER PNEUMONITIS SCREEN (B),1292480,CDM,300,RC,86606,HCPCS,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,60.59,
IGF BP3,1292481,CDM,300,RC,83519,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.89,79.68,
"C1 INHIBITOR, PROTEIN",1292482,CDM,300,RC,86160,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.86,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.57,71.38,
GENTAMICIN RANDOM,1292483,CDM,300,RC,80170,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.61,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.43,135.29,
EVEROLIMUS,1292484,CDM,300,RC,83789,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,35.69,
BILE ACIDS F/T PREGNANCY,1292485,CDM,300,RC,83789,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,35.69,
"EOSINOPHIL COUNT, URINE",1292486,CDM,300,RC,87205,HCPCS,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.95,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,5.27,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.07,6.64,
GLYCOMARK,1292487,CDM,300,RC,84378,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.21,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.14,68.06,
CHROMOSOMAL MICROARRAY POSTNAT,1292488,CDM,300,RC,81229,HCPCS,outpatient,,,2882,1441,,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,1160,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2320,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2320,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,2161.5,75,,1729.2,percent of total billed charges,75% of total billed charges for outpatient setting,2161.5,75,,1729.2,percent of total billed charges,75% of total billed charges for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,2161.5,75,,1729.2,percent of total billed charges,75% of total billed charges for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2436,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,2247.96,78,,1798.368,percent of total billed charges,78% of total billed charges for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,2017.4,70,,1613.92,percent of total billed charges,70% of total billed charges for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2161.5,75,,1729.2,percent of total billed charges,75% of total billed charges for outpatient setting,2392.06,83,,1913.648,percent of total billed charges,83% of total billed charges for outpatient setting,1441,50,,1152.8,percent of total billed charges,50% of total billed charges for outpatient setting,1441,50,,1152.8,percent of total billed charges,50% of total billed charges for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1624,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,1160,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1160,2436,
HYMENOPTERA PANEL,1292489,CDM,300,RC,86003,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,6.9,
HYMENOPTERA PANEL (B),1292490,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
HYMENOPTERA PANEL (B),1292491,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
HYMENOPTERA PANEL (B),1292492,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
HYMENOPTERA PANEL (B),1292493,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
HYMENOPTERA PANEL (B),1292494,CDM,300,RC,86003,HCPCS,outpatient,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,29.88,
LYMPHOCYTE SUBSET PANEL 2,1292495,CDM,300,RC,,,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.75,35,,51.8,percent of total billed charges,35% of total billed charges for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.46,39.17,,57.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.75,153.55,
LYMPHOCYTE SUBSET PANEL 2(B),1292496,CDM,300,RC,86355,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,67.23,
LYMPHOCYTE SUBSET PANEL 2 (B),1292497,CDM,300,RC,86359,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,29.62,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.1,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,37.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.73,67.23,
LYMPHOCYTE SUBSET PANEL (B),1292498,CDM,300,RC,86360,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,134.46,
LACTOFERRIN QUAL STOOL,1292499,CDM,300,RC,83630,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,19.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,19.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,58.1,
LATEX IGE,1292500,CDM,300,RC,86003,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,15.77,
LYMPHOCYTE SUBSET PANEL 5,1292501,CDM,300,RC,86361,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,26.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.97,153.55,
GRP 3 AG SCREEN,1292504,CDM,300,RC,,,outpatient,,,145,72.5,,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.75,35,,40.6,percent of total billed charges,35% of total billed charges for outpatient setting,113.1,78,,90.48,percent of total billed charges,78% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,120.35,83,,96.28,percent of total billed charges,83% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.79,39.17,,45.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,50.75,120.35,
FOOD ALLERGY PROFILE,1292505,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292506,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292507,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292508,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292509,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292510,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292511,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292512,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292513,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292514,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292515,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292516,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
FOOD ALLERGY PROFILE (B),1292517,CDM,300,RC,86003,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,31.54,
ANTI IGE IGG,1292518,CDM,300,RC,83520,HCPCS,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.4,39.01,
LACOSAMIDE (VIMPAT),1292519,CDM,300,RC,80299,HCPCS,outpatient,,,179,89.5,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,139.62,78,,111.696,percent of total billed charges,78% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,148.57,83,,118.856,percent of total billed charges,83% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,148.57,
QUANTIFERON TB GOLD,1292520,CDM,300,RC,86480,HCPCS,outpatient,,,526,263,,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,61.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,77.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,394.5,75,,315.6,percent of total billed charges,75% of total billed charges for outpatient setting,394.5,75,,315.6,percent of total billed charges,75% of total billed charges for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,394.5,75,,315.6,percent of total billed charges,75% of total billed charges for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,410.28,78,,328.224,percent of total billed charges,78% of total billed charges for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,368.2,70,,294.56,percent of total billed charges,70% of total billed charges for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,394.5,75,,315.6,percent of total billed charges,75% of total billed charges for outpatient setting,436.58,83,,349.264,percent of total billed charges,83% of total billed charges for outpatient setting,263,50,,210.4,percent of total billed charges,50% of total billed charges for outpatient setting,263,50,,210.4,percent of total billed charges,50% of total billed charges for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.55,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,61.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.55,436.58,
INFLAMMATORY BOWEL DISEASE,1292521,CDM,300,RC,86021,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,19.88,
INFLAMMATORY BOWEL DISEASE (B),1292522,CDM,300,RC,86021,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,86.32,
INFLAMMATORY BOWEL DISEASE (B),1292523,CDM,300,RC,86021,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,86.32,
INFLAMMATORY BOWEL DISEASE (B),1292524,CDM,300,RC,86021,HCPCS,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.88,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,15.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.25,86.32,
INFLAMMATORY BOWEL DISEASE,1292525,CDM,300,RC,86671,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,69.72,
INFLAMMATORY BOWEL DISEASE (B),1292526,CDM,300,RC,86671,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,69.72,
INFLAMMATORY BOWEL DISEASE (B),1292527,CDM,300,RC,86671,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.19,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.25,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.79,69.72,
18 HYDROXYCORTISOL FREE 24HR,1292528,CDM,300,RC,83789,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.55,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.93,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,24.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.29,35.69,
BB PT RBC ANTIGEN TYP  CCEEK,1292529,CDM,300,RC,86905,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
BB PATIENT RBC ANTIGEN TYPE OTHER,1292530,CDM,300,RC,86905,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
HEMOGLOBIN S,1292531,CDM,300,RC,85660,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.86,33.2,
CMV TEST,1292532,CDM,300,RC,86644,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,66.4,
BB ANTIBODY SCREEN EACH MEDIA SCB,1292533,CDM,300,RC,86850,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.23,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,9.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.66,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.77,109.56,
AB ID EACH PANEL & MEDIA SCBC,1292534,CDM,300,RC,86870,HCPCS,outpatient,,,342,171,,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,256.5,75,,205.2,percent of total billed charges,75% of total billed charges for outpatient setting,256.5,75,,205.2,percent of total billed charges,75% of total billed charges for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,256.5,75,,205.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,266.76,78,,213.408,percent of total billed charges,78% of total billed charges for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,239.4,70,,191.52,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.5,75,,205.2,percent of total billed charges,75% of total billed charges for outpatient setting,283.86,83,,227.088,percent of total billed charges,83% of total billed charges for outpatient setting,171,50,,136.8,percent of total billed charges,50% of total billed charges for outpatient setting,171,50,,136.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.28,308.75,
BB DAR EACH ANTISERA,1292535,CDM,300,RC,86880,HCPCS,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,6.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.09,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,52.54,
AB ID EACH SELECTED REAGENT CE,1292536,CDM,300,RC,86885,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,146.71,
ANTIBODY TITRATION STUDIES,1292537,CDM,300,RC,86886,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.1,146.71,
BB ABO TYPE,1292538,CDM,300,RC,86900,HCPCS,outpatient,,,64.4,32.2,,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,50.23,78,,40.184,percent of total billed charges,78% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,45.08,70,,36.064,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.3,75,,38.64,percent of total billed charges,75% of total billed charges for outpatient setting,53.45,83,,42.76,percent of total billed charges,83% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,32.2,50,,25.76,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.63,109.72,
BB RH (D) TYPE,1292539,CDM,300,RC,86901,HCPCS,outpatient,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.69,116.2,
C E K AND SICKLE NEGATIVE,1292540,CDM,300,RC,86902,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.52,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,308.75,
HISTORICAL TYP PER ANTI CCEEK,1292541,CDM,300,RC,86902,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.52,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,308.75,
HISTORICAL TYP PER ANTI OTHER,1292542,CDM,300,RC,86902,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.52,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.01,308.75,
PATIENT RH PHENOTYPE C C E E,1292543,CDM,300,RC,86906,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.83,45.65,
BB IMMEDIATE SPIN PHASE OF CROSSM,1292544,CDM,300,RC,86920,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.33,146.71,
BB AHG PHASE OF CROSSMATCH,1292545,CDM,300,RC,86922,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.6,146.71,
ANTIGEN SCREEN 1-20 TESTS,1292546,CDM,300,RC,86905,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
ANTIGEN SCREEN 21-50 TESTS,1292547,CDM,300,RC,86905,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
ANTIGEN  SCREEN 51+ TEST,1292548,CDM,300,RC,86905,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.81,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.37,308.75,
AB ID SELECT CELL PANEL PER CE,1292549,CDM,300,RC,86885,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,7.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.55,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.03,146.71,
PRETREATMENT OF RBC INCUB W CH,1292550,CDM,300,RC,86971,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,146.71,
RETICULOCYTE SEPARATION,1292551,CDM,300,RC,86972,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.05,146.71,
ZIPRASIDONE,1292552,CDM,300,RC,80299,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,71.38,
"TCELL CLONALITY PANEL(TCRG,TCR",1292553,CDM,300,RC,81342,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,201.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,172.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,201.5,
TCELL CLONALITY PANEL (B),1292554,CDM,300,RC,81342,HCPCS,outpatient,,,712,356,,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,201.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,164,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,534,75,,427.2,percent of total billed charges,75% of total billed charges for outpatient setting,534,75,,427.2,percent of total billed charges,75% of total billed charges for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,534,75,,427.2,percent of total billed charges,75% of total billed charges for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,172.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,555.36,78,,444.288,percent of total billed charges,78% of total billed charges for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,498.4,70,,398.72,percent of total billed charges,70% of total billed charges for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,534,75,,427.2,percent of total billed charges,75% of total billed charges for outpatient setting,590.96,83,,472.768,percent of total billed charges,83% of total billed charges for outpatient setting,356,50,,284.8,percent of total billed charges,50% of total billed charges for outpatient setting,356,50,,284.8,percent of total billed charges,50% of total billed charges for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,201.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,590.96,
TCELL CLONALITY PANEL (B),1292555,CDM,300,RC,81340,HCPCS,outpatient,,,737,368.5,,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,208.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,552.75,75,,442.2,percent of total billed charges,75% of total billed charges for outpatient setting,552.75,75,,442.2,percent of total billed charges,75% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,552.75,75,,442.2,percent of total billed charges,75% of total billed charges for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,574.86,78,,459.888,percent of total billed charges,78% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,552.75,75,,442.2,percent of total billed charges,75% of total billed charges for outpatient setting,611.71,83,,489.368,percent of total billed charges,83% of total billed charges for outpatient setting,368.5,50,,294.8,percent of total billed charges,50% of total billed charges for outpatient setting,368.5,50,,294.8,percent of total billed charges,50% of total billed charges for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,208.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,611.71,
TCELL CLONALITY PANEL (B),1292556,CDM,300,RC,G0452,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,85.49,
"BK VIRUS QUANT, URINE",1292557,CDM,300,RC,87799,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.2,35,,42.56,percent of total billed charges,35% of total billed charges for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.54,39.17,,47.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,42.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.84,126.16,
FLECAINIDE,1292559,CDM,300,RC,80299,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,18.64,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.6,70.55,
PAIN MANAGEMENT (B),1292560,CDM,300,RC,81226,HCPCS,outpatient,,,2324,1162,,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,450.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,40,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,1743,75,,1394.4,percent of total billed charges,75% of total billed charges for outpatient setting,1743,75,,1394.4,percent of total billed charges,75% of total billed charges for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,1743,75,,1394.4,percent of total billed charges,75% of total billed charges for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1812.72,78,,1450.176,percent of total billed charges,78% of total billed charges for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,1626.8,70,,1301.44,percent of total billed charges,70% of total billed charges for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1743,75,,1394.4,percent of total billed charges,75% of total billed charges for outpatient setting,1928.92,83,,1543.136,percent of total billed charges,83% of total billed charges for outpatient setting,1162,50,,929.6,percent of total billed charges,50% of total billed charges for outpatient setting,1162,50,,929.6,percent of total billed charges,50% of total billed charges for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,450.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,1928.92,
PAIN MANAGEMENT (B),1292561,CDM,300,RC,81225,HCPCS,outpatient,,,1501,750.5,,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,291.36,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,244,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,244,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,1125.75,75,,900.6,percent of total billed charges,75% of total billed charges for outpatient setting,1125.75,75,,900.6,percent of total billed charges,75% of total billed charges for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,1125.75,75,,900.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1170.78,78,,936.624,percent of total billed charges,78% of total billed charges for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,1050.7,70,,840.56,percent of total billed charges,70% of total billed charges for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1125.75,75,,900.6,percent of total billed charges,75% of total billed charges for outpatient setting,1245.83,83,,996.664,percent of total billed charges,83% of total billed charges for outpatient setting,750.5,50,,600.4,percent of total billed charges,50% of total billed charges for outpatient setting,750.5,50,,600.4,percent of total billed charges,50% of total billed charges for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,291.36,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.8,1245.83,
NICOTINE AND COTININE URINE,1292562,CDM,300,RC,80323,HCPCS,outpatient,,,166,83,,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.64,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,129.48,78,,103.584,percent of total billed charges,78% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.78,83,,110.224,percent of total billed charges,83% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.43,137.78,
PAIN MANAGEMENT FENTANYL,1292563,CDM,300,RC,80305,HCPCS,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,11.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.03,158.53,
"PARIETAL CELL ANTIBODY, ELISA",1292566,CDM,300,RC,83516,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,63.08,
RIBOSOMAL P ANTIBODY,1292567,CDM,300,RC,83516,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.12,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.53,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.42,63.08,
PAIN MGT PROF 1 W/ CONF,1292568,CDM,300,RC,80307,HCPCS,outpatient,,,394,197,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,307.32,78,,245.856,percent of total billed charges,78% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,327.02,83,,261.616,percent of total billed charges,83% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,327.02,
5'NUCLEOTIDASE,1292569,CDM,300,RC,83915,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.15,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.81,33.2,
ALK PHOS BONE SPECIFIC,1292570,CDM,300,RC,84075,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.45,15.77,
SIROLIMUS/RAPAMYCIN,1292571,CDM,300,RC,80195,HCPCS,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.25,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.11,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.08,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,13.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.08,40.67,
STONE RISK DIAGNOSTIC (B),1292573,CDM,300,RC,82140,HCPCS,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.44,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.44,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.99,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.06,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.71,28.22,
STONE RISK DIAGONSTIC (B),1292580,CDM,300,RC,82340,HCPCS,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.97,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.31,17.43,
STONE RISK DIAGONSTIC,1292581,CDM,300,RC,82507,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.48,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.48,81.34,
STONE RISK DIAGONSTIC (B),1292582,CDM,300,RC,82570,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,14.94,
STONE RISK DIAGONSTIC (B),1292583,CDM,300,RC,83735,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.7,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.89,19.09,
STONE RISK DIAGONSTIC (B),1292584,CDM,300,RC,83945,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,36.52,
STONE RISK DIAGONSTIC (B),1292585,CDM,300,RC,83986,HCPCS,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,3.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.15,9.96,
STONE RISK DIAGONSTIC (B),1292586,CDM,300,RC,84105,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.51,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.56,14.94,
STONE RISK DIAGONSTIC (B),1292587,CDM,300,RC,84133,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.41,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.68,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.79,12.45,
STONE RISK DIAGONSTIC (B),1292588,CDM,300,RC,84300,HCPCS,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3.05,9.96,
STONE RISK DIAGONSTIC (B),1292589,CDM,300,RC,84392,HCPCS,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,5.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.98,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,5.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.19,13.28,
"ADENOVIRUS AB, SERUM",1292590,CDM,300,RC,86603,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.33,73.04,
"PAIN MGT OPIATES, EXPANDED QUA",1295581,CDM,300,RC,G0481,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,156.59,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,128.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,128.79,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,156.59,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,156.59,
"HEP B CORE AB, TOTAL",1295582,CDM,300,RC,86704,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.92,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,12.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.61,36.52,
"ALPHA-GAL, IGE",1295583,CDM,300,RC,86001,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,7.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.6,15.77,
ENTAMOEBA HISTOLYTICA ANTI EIA,1295584,CDM,300,RC,87337,HCPCS,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.08,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.83,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,11.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.56,35.69,
DIHYDROTESTOSTERONE,1295585,CDM,300,RC,82642,HCPCS,outpatient,,,216,108,,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,29.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.32,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,168.48,78,,134.784,percent of total billed charges,78% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.28,83,,143.424,percent of total billed charges,83% of total billed charges for outpatient setting,108,50,,86.4,percent of total billed charges,50% of total billed charges for outpatient setting,108,50,,86.4,percent of total billed charges,50% of total billed charges for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.21,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,29.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.21,179.28,
OCCULT BLOOD #2,1296007,CDM,300,RC,82272,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,19.09,
OCCULT BLOOD #3,1296008,CDM,300,RC,82272,HCPCS,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.04,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,4.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2.83,19.09,
AIRBORNE ALLERGY TEST,1296015,CDM,300,RC,,,outpatient,,,1248,624,,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,479.23,38.4,,383.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,479.23,38.4,,383.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,936,75,,748.8,percent of total billed charges,75% of total billed charges for outpatient setting,936,75,,748.8,percent of total billed charges,75% of total billed charges for outpatient setting,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,936,75,,748.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,436.8,35,,349.44,percent of total billed charges,35% of total billed charges for outpatient setting,973.44,78,,778.752,percent of total billed charges,78% of total billed charges for outpatient setting,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,873.6,70,,698.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,936,75,,748.8,percent of total billed charges,75% of total billed charges for outpatient setting,1035.84,83,,828.672,percent of total billed charges,83% of total billed charges for outpatient setting,624,50,,499.2,percent of total billed charges,50% of total billed charges for outpatient setting,624,50,,499.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,488.81,39.17,,391.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,436.8,1035.84,
DIETARY ANTIGEN PANEL 588G & 588E,1296016,CDM,300,RC,,,outpatient,,,4663.55,2331.78,,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1790.8,38.4,,1432.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1790.8,38.4,,1432.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,3497.66,75,,2798.128,percent of total billed charges,75% of total billed charges for outpatient setting,3497.66,75,,2798.128,percent of total billed charges,75% of total billed charges for outpatient setting,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,3497.66,75,,2798.128,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1632.24,35,,1305.792,percent of total billed charges,35% of total billed charges for outpatient setting,3637.57,78,,2910.056,percent of total billed charges,78% of total billed charges for outpatient setting,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,3264.49,70,,2611.592,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3497.66,75,,2798.128,percent of total billed charges,75% of total billed charges for outpatient setting,3870.75,83,,3096.6,percent of total billed charges,83% of total billed charges for outpatient setting,2331.78,50,,1865.424,percent of total billed charges,50% of total billed charges for outpatient setting,2331.78,50,,1865.424,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1826.62,39.17,,1461.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1632.24,3870.75,
HDL,1296017,CDM,300,RC,83718,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.21,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,8.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.21,23.24,
CORTISOL,1296018,CDM,300,RC,82533,HCPCS,outpatient,,,88.2,44.1,,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,16.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,20.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,66.15,75,,52.92,percent of total billed charges,75% of total billed charges for outpatient setting,66.15,75,,52.92,percent of total billed charges,75% of total billed charges for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,66.15,75,,52.92,percent of total billed charges,75% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.53,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,68.8,78,,55.04,percent of total billed charges,78% of total billed charges for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,61.74,70,,49.392,percent of total billed charges,70% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.15,75,,52.92,percent of total billed charges,75% of total billed charges for outpatient setting,73.21,83,,58.568,percent of total billed charges,83% of total billed charges for outpatient setting,44.1,50,,35.28,percent of total billed charges,50% of total billed charges for outpatient setting,44.1,50,,35.28,percent of total billed charges,50% of total billed charges for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,16.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.35,73.21,
DRUG SCREEN URINE MEDICAL,1296019,CDM,301,RC,80307,HCPCS,outpatient,,,279,139.5,,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,217.62,78,,174.096,percent of total billed charges,78% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,231.57,83,,185.256,percent of total billed charges,83% of total billed charges for outpatient setting,139.5,50,,111.6,percent of total billed charges,50% of total billed charges for outpatient setting,139.5,50,,111.6,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,231.57,
DRUG CONF DEF 1-7 CLASSES,1296021,CDM,300,RC,80307,HCPCS,outpatient,,,548.02,274.01,,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,61.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,411.02,75,,328.816,percent of total billed charges,75% of total billed charges for outpatient setting,411.02,75,,328.816,percent of total billed charges,75% of total billed charges for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,411.02,75,,328.816,percent of total billed charges,75% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,427.46,78,,341.968,percent of total billed charges,78% of total billed charges for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,383.61,70,,306.888,percent of total billed charges,70% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,411.02,75,,328.816,percent of total billed charges,75% of total billed charges for outpatient setting,454.86,83,,363.888,percent of total billed charges,83% of total billed charges for outpatient setting,274.01,50,,219.208,percent of total billed charges,50% of total billed charges for outpatient setting,274.01,50,,219.208,percent of total billed charges,50% of total billed charges for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,62.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.81,454.86,
DRUG TEST DEF 8-14 CLASSES,1296022,CDM,301,RC,,,outpatient,,,613,306.5,,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,235.39,38.4,,188.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,214.55,35,,171.64,percent of total billed charges,35% of total billed charges for outpatient setting,478.14,78,,382.512,percent of total billed charges,78% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,429.1,70,,343.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,459.75,75,,367.8,percent of total billed charges,75% of total billed charges for outpatient setting,508.79,83,,407.032,percent of total billed charges,83% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,306.5,50,,245.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240.1,39.17,,192.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,214.55,508.79,
DRUG TEST DEF 15-21 CLASSES,1296023,CDM,300,RC,,,outpatient,,,728,364,,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279.55,38.4,,223.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.55,38.4,,223.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,546,75,,436.8,percent of total billed charges,75% of total billed charges for outpatient setting,546,75,,436.8,percent of total billed charges,75% of total billed charges for outpatient setting,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,546,75,,436.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,254.8,35,,203.84,percent of total billed charges,35% of total billed charges for outpatient setting,567.84,78,,454.272,percent of total billed charges,78% of total billed charges for outpatient setting,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,509.6,70,,407.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,546,75,,436.8,percent of total billed charges,75% of total billed charges for outpatient setting,604.24,83,,483.392,percent of total billed charges,83% of total billed charges for outpatient setting,364,50,,291.2,percent of total billed charges,50% of total billed charges for outpatient setting,364,50,,291.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,285.14,39.17,,228.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,254.8,604.24,
DRUG TEST DEF 22+ CLASSES,1296024,CDM,300,RC,,,outpatient,,,780,390,,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.52,38.4,,239.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,299.52,38.4,,239.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,273,35,,218.4,percent of total billed charges,35% of total billed charges for outpatient setting,608.4,78,,486.72,percent of total billed charges,78% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,647.4,83,,517.92,percent of total billed charges,83% of total billed charges for outpatient setting,390,50,,312,percent of total billed charges,50% of total billed charges for outpatient setting,390,50,,312,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,305.51,39.17,,244.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,273,647.4,
LYPHOCYTE SUBSET PANEL 4,1296029,CDM,300,RC,86360,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.36,153.55,
RESPIRATORY PATHOGEN PANEL,1296031,CDM,300,RC,87633,HCPCS,outpatient,,,1726,863,,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,416.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,193.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,193.9,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,1294.5,75,,1035.6,percent of total billed charges,75% of total billed charges for outpatient setting,1294.5,75,,1035.6,percent of total billed charges,75% of total billed charges for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,1294.5,75,,1035.6,percent of total billed charges,75% of total billed charges for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1346.28,78,,1077.024,percent of total billed charges,78% of total billed charges for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,1208.2,70,,966.56,percent of total billed charges,70% of total billed charges for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1294.5,75,,1035.6,percent of total billed charges,75% of total billed charges for outpatient setting,1432.58,83,,1146.064,percent of total billed charges,83% of total billed charges for outpatient setting,863,50,,690.4,percent of total billed charges,50% of total billed charges for outpatient setting,863,50,,690.4,percent of total billed charges,50% of total billed charges for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,416.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.73,1432.58,
LAB HANDLING FEE,1299999,CDM,300,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
CONTRAST PROHANCE,1300041,CDM,636,RC,A9579,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MULTIHANCE,1300042,CDM,636,RC,A9577,HCPCS,both,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
MRI CHEST W/CON,1310473,CDM,610,RC,71551,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,1093.11,
MRI TMJ,1310474,CDM,610,RC,70336,HCPCS,outpatient,,,910,455,,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.5,35,,254.8,percent of total billed charges,35% of total billed charges for outpatient setting,709.8,78,,567.84,percent of total billed charges,78% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,682.5,75,,546,percent of total billed charges,75% of total billed charges for outpatient setting,755.3,83,,604.24,percent of total billed charges,83% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,356.43,39.17,,285.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,755.3,
MRI UPPER JOINT W/O CONT LEFT,1310482,CDM,610,RC,73221,HCPCS,outpatient,,,3746.4,1873.2,,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1311.24,35,,1048.992,percent of total billed charges,35% of total billed charges for outpatient setting,2922.19,78,,2337.752,percent of total billed charges,78% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2809.8,75,,2247.84,percent of total billed charges,75% of total billed charges for outpatient setting,3109.51,83,,2487.608,percent of total billed charges,83% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1467.39,39.17,,1173.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,3109.51,
MRI LOWER EXT JOINT W/O CONT L,1310484,CDM,610,RC,73721,HCPCS,outpatient,,,3746.4,1873.2,,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1311.24,35,,1048.992,percent of total billed charges,35% of total billed charges for outpatient setting,2922.19,78,,2337.752,percent of total billed charges,78% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2809.8,75,,2247.84,percent of total billed charges,75% of total billed charges for outpatient setting,3109.51,83,,2487.608,percent of total billed charges,83% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1467.39,39.17,,1173.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,3109.51,
MRI ANGIO C-SPINE W & W/0,1310600,CDM,610,RC,72159,HCPCS,outpatient,,,1736,868,,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,666.62,38.4,,533.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,666.62,38.4,,533.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,607.6,35,,486.08,percent of total billed charges,35% of total billed charges for outpatient setting,1354.08,78,,1083.264,percent of total billed charges,78% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,1215.2,70,,972.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1302,75,,1041.6,percent of total billed charges,75% of total billed charges for outpatient setting,1440.88,83,,1152.704,percent of total billed charges,83% of total billed charges for outpatient setting,868,50,,694.4,percent of total billed charges,50% of total billed charges for outpatient setting,868,50,,694.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,679.95,39.17,,543.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600,1440.88,
MRI ANGIO D-SPINE W & W/O CON,1310601,CDM,610,RC,72157,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI ANGIO L-SPINE W & W/O,1310604,CDM,610,RC,72158,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI PELVIS W/CONTRAST,1310605,CDM,610,RC,72196,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI LOWER EXT NON-JOINT W&WO C,1322900,CDM,610,RC,73720,HCPCS,outpatient,,,1198,599,,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,460.03,38.4,,368.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,460.03,38.4,,368.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,419.3,35,,335.44,percent of total billed charges,35% of total billed charges for outpatient setting,934.44,78,,747.552,percent of total billed charges,78% of total billed charges for outpatient setting,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.5,75,,718.8,percent of total billed charges,75% of total billed charges for outpatient setting,994.34,83,,795.472,percent of total billed charges,83% of total billed charges for outpatient setting,599,50,,479.2,percent of total billed charges,50% of total billed charges for outpatient setting,599,50,,479.2,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,469.23,39.17,,375.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,994.34,
MRI CHEST W&W/O CONT,1332323,CDM,610,RC,71552,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI BRAIN W&W/O CONT,1333331,CDM,611,RC,70553,HCPCS,outpatient,,,6266.4,3133.2,,4386.48,70,,3509.184,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2406.3,38.4,,1925.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2406.3,38.4,,1925.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2193.24,35,,1754.592,percent of total billed charges,35% of total billed charges for outpatient setting,4887.79,78,,3910.232,percent of total billed charges,78% of total billed charges for outpatient setting,4386.48,70,,3509.184,percent of total billed charges,70% of total billed charges for outpatient setting,4386.48,70,,3509.184,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4699.8,75,,3759.84,percent of total billed charges,75% of total billed charges for outpatient setting,5201.11,83,,4160.888,percent of total billed charges,83% of total billed charges for outpatient setting,3133.2,50,,2506.56,percent of total billed charges,50% of total billed charges for outpatient setting,3133.2,50,,2506.56,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2454.43,39.17,,1963.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,5201.11,
"MRI ORBIT,HEAD NECK W/O CONTRA",1333332,CDM,610,RC,70540,HCPCS,outpatient,,,722,361,,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.7,35,,202.16,percent of total billed charges,35% of total billed charges for outpatient setting,563.16,78,,450.528,percent of total billed charges,78% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,541.5,75,,433.2,percent of total billed charges,75% of total billed charges for outpatient setting,599.26,83,,479.408,percent of total billed charges,83% of total billed charges for outpatient setting,361,50,,288.8,percent of total billed charges,50% of total billed charges for outpatient setting,361,50,,288.8,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,282.8,39.17,,226.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,600,
MRI CHEST W/O CONT,1333333,CDM,610,RC,71550,HCPCS,outpatient,,,987,493.5,,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,379.01,38.4,,303.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,379.01,38.4,,303.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.45,35,,276.36,percent of total billed charges,35% of total billed charges for outpatient setting,769.86,78,,615.888,percent of total billed charges,78% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,690.9,70,,552.72,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,740.25,75,,592.2,percent of total billed charges,75% of total billed charges for outpatient setting,819.21,83,,655.368,percent of total billed charges,83% of total billed charges for outpatient setting,493.5,50,,394.8,percent of total billed charges,50% of total billed charges for outpatient setting,493.5,50,,394.8,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.59,39.17,,309.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,819.21,
MRI C-SPINE W&W/O CO,1333334,CDM,612,RC,72156,HCPCS,outpatient,,,3197,1598.5,,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1227.65,38.4,,982.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1227.65,38.4,,982.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1118.95,35,,895.16,percent of total billed charges,35% of total billed charges for outpatient setting,2493.66,78,,1994.928,percent of total billed charges,78% of total billed charges for outpatient setting,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2397.75,75,,1918.2,percent of total billed charges,75% of total billed charges for outpatient setting,2653.51,83,,2122.808,percent of total billed charges,83% of total billed charges for outpatient setting,1598.5,50,,1278.8,percent of total billed charges,50% of total billed charges for outpatient setting,1598.5,50,,1278.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1252.2,39.17,,1001.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,2653.51,
MRI T-SPINE W&W/O CO,1333335,CDM,612,RC,72157,HCPCS,outpatient,,,3197,1598.5,,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1227.65,38.4,,982.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1227.65,38.4,,982.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1118.95,35,,895.16,percent of total billed charges,35% of total billed charges for outpatient setting,2493.66,78,,1994.928,percent of total billed charges,78% of total billed charges for outpatient setting,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,2237.9,70,,1790.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2397.75,75,,1918.2,percent of total billed charges,75% of total billed charges for outpatient setting,2653.51,83,,2122.808,percent of total billed charges,83% of total billed charges for outpatient setting,1598.5,50,,1278.8,percent of total billed charges,50% of total billed charges for outpatient setting,1598.5,50,,1278.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1252.2,39.17,,1001.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,2653.51,
MRI L-SPINE W&W/O CO,1333336,CDM,612,RC,72158,HCPCS,outpatient,,,4476,2238,,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1718.78,38.4,,1375.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1718.78,38.4,,1375.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.6,35,,1253.28,percent of total billed charges,35% of total billed charges for outpatient setting,3491.28,78,,2793.024,percent of total billed charges,78% of total billed charges for outpatient setting,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3357,75,,2685.6,percent of total billed charges,75% of total billed charges for outpatient setting,3715.08,83,,2972.064,percent of total billed charges,83% of total billed charges for outpatient setting,2238,50,,1790.4,percent of total billed charges,50% of total billed charges for outpatient setting,2238,50,,1790.4,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1753.16,39.17,,1402.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,3715.08,
MRI UPPER EXT W&WO NONJT LEFT,1333339,CDM,610,RC,73220,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI-ABDOMEN W/O CONTRAST,1333340,CDM,610,RC,74181,HCPCS,outpatient,,,910,455,,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,349.44,38.4,,279.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.5,35,,254.8,percent of total billed charges,35% of total billed charges for outpatient setting,709.8,78,,567.84,percent of total billed charges,78% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,637,70,,509.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,682.5,75,,546,percent of total billed charges,75% of total billed charges for outpatient setting,755.3,83,,604.24,percent of total billed charges,83% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,455,50,,364,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,356.43,39.17,,285.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,755.3,
MRI BRAIN W/O CONTRS,1333341,CDM,611,RC,70551,HCPCS,outpatient,,,1612.04,806.02,,1128.43,70,,902.744,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,619.02,38.4,,495.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.02,38.4,,495.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,564.21,35,,451.368,percent of total billed charges,35% of total billed charges for outpatient setting,1257.39,78,,1005.912,percent of total billed charges,78% of total billed charges for outpatient setting,1128.43,70,,902.744,percent of total billed charges,70% of total billed charges for outpatient setting,1128.43,70,,902.744,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1209.03,75,,967.224,percent of total billed charges,75% of total billed charges for outpatient setting,1337.99,83,,1070.392,percent of total billed charges,83% of total billed charges for outpatient setting,806.02,50,,644.816,percent of total billed charges,50% of total billed charges for outpatient setting,806.02,50,,644.816,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,631.4,39.17,,505.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,1337.99,
MRI BRAIN W/ CONTRST,1333342,CDM,611,RC,70552,HCPCS,outpatient,,,1843,921.5,,1290.1,70,,1032.08,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,707.71,38.4,,566.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,707.71,38.4,,566.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,645.05,35,,516.04,percent of total billed charges,35% of total billed charges for outpatient setting,1437.54,78,,1150.032,percent of total billed charges,78% of total billed charges for outpatient setting,1290.1,70,,1032.08,percent of total billed charges,70% of total billed charges for outpatient setting,1290.1,70,,1032.08,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1382.25,75,,1105.8,percent of total billed charges,75% of total billed charges for outpatient setting,1529.69,83,,1223.752,percent of total billed charges,83% of total billed charges for outpatient setting,921.5,50,,737.2,percent of total billed charges,50% of total billed charges for outpatient setting,921.5,50,,737.2,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,721.86,39.17,,577.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1529.69,
MRI C-SPINE W/O CONT,1333343,CDM,612,RC,72141,HCPCS,outpatient,,,3746.4,1873.2,,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1311.24,35,,1048.992,percent of total billed charges,35% of total billed charges for outpatient setting,2922.19,78,,2337.752,percent of total billed charges,78% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2809.8,75,,2247.84,percent of total billed charges,75% of total billed charges for outpatient setting,3109.51,83,,2487.608,percent of total billed charges,83% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1467.39,39.17,,1173.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,3109.51,
MRI C-SPINE W/CONTR,1333344,CDM,612,RC,72142,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI T-SPINE W/O CONT,1333345,CDM,612,RC,72146,HCPCS,outpatient,,,547,273.5,,382.9,70,,306.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,210.05,38.4,,168.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,210.05,38.4,,168.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.45,35,,153.16,percent of total billed charges,35% of total billed charges for outpatient setting,426.66,78,,341.328,percent of total billed charges,78% of total billed charges for outpatient setting,382.9,70,,306.32,percent of total billed charges,70% of total billed charges for outpatient setting,382.9,70,,306.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,410.25,75,,328.2,percent of total billed charges,75% of total billed charges for outpatient setting,454.01,83,,363.208,percent of total billed charges,83% of total billed charges for outpatient setting,273.5,50,,218.8,percent of total billed charges,50% of total billed charges for outpatient setting,273.5,50,,218.8,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,214.25,39.17,,171.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.45,600,
MRI T-SPINE W/CONTRA,1333346,CDM,612,RC,72147,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI L-SPINE W/O CONT,1333347,CDM,612,RC,72148,HCPCS,outpatient,,,3746.4,1873.2,,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1311.24,35,,1048.992,percent of total billed charges,35% of total billed charges for outpatient setting,2922.19,78,,2337.752,percent of total billed charges,78% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2809.8,75,,2247.84,percent of total billed charges,75% of total billed charges for outpatient setting,3109.51,83,,2487.608,percent of total billed charges,83% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1467.39,39.17,,1173.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,3109.51,
MRI L-SPINE W/CONTRA,1333348,CDM,612,RC,72149,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI LOWER EXT ANGIO LEFT,1333350,CDM,610,RC,73725,HCPCS,outpatient,,,958,479,,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,335.3,35,,268.24,percent of total billed charges,35% of total billed charges for outpatient setting,747.24,78,,597.792,percent of total billed charges,78% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,718.5,75,,574.8,percent of total billed charges,75% of total billed charges for outpatient setting,795.14,83,,636.112,percent of total billed charges,83% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.23,39.17,,300.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,335.3,795.14,
MRI THORACIC AORTA ANGIO,1333351,CDM,610,RC,71555,HCPCS,outpatient,,,951,475.5,,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.18,38.4,,292.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,365.18,38.4,,292.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,332.85,35,,266.28,percent of total billed charges,35% of total billed charges for outpatient setting,741.78,78,,593.424,percent of total billed charges,78% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,713.25,75,,570.6,percent of total billed charges,75% of total billed charges for outpatient setting,789.33,83,,631.464,percent of total billed charges,83% of total billed charges for outpatient setting,475.5,50,,380.4,percent of total billed charges,50% of total billed charges for outpatient setting,475.5,50,,380.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,372.48,39.17,,297.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,332.85,789.33,
MRA ABD W/OR W/O CONTRAST,1333352,CDM,610,RC,74185,HCPCS,outpatient,,,1441,720.5,,1008.7,70,,806.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,553.34,38.4,,442.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553.34,38.4,,442.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,504.35,35,,403.48,percent of total billed charges,35% of total billed charges for outpatient setting,1123.98,78,,899.184,percent of total billed charges,78% of total billed charges for outpatient setting,1008.7,70,,806.96,percent of total billed charges,70% of total billed charges for outpatient setting,1008.7,70,,806.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1080.75,75,,864.6,percent of total billed charges,75% of total billed charges for outpatient setting,1196.03,83,,956.824,percent of total billed charges,83% of total billed charges for outpatient setting,720.5,50,,576.4,percent of total billed charges,50% of total billed charges for outpatient setting,720.5,50,,576.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,564.41,39.17,,451.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,504.35,1196.03,
MRA HEAD W/O CONTRAST,1333354,CDM,611,RC,70544,HCPCS,outpatient,,,2676,1338,,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,936.6,35,,749.28,percent of total billed charges,35% of total billed charges for outpatient setting,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2007,75,,1605.6,percent of total billed charges,75% of total billed charges for outpatient setting,2221.08,83,,1776.864,percent of total billed charges,83% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1048.13,39.17,,838.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,2221.08,
MRA HEAD W/ CONTRAST,1333355,CDM,611,RC,70545,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRA NECK W/O CONTRAST,1333356,CDM,611,RC,70547,HCPCS,outpatient,,,936,468,,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,359.42,38.4,,287.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,359.42,38.4,,287.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,327.6,35,,262.08,percent of total billed charges,35% of total billed charges for outpatient setting,730.08,78,,584.064,percent of total billed charges,78% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,702,75,,561.6,percent of total billed charges,75% of total billed charges for outpatient setting,776.88,83,,621.504,percent of total billed charges,83% of total billed charges for outpatient setting,468,50,,374.4,percent of total billed charges,50% of total billed charges for outpatient setting,468,50,,374.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,366.61,39.17,,293.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,776.88,
MRA NECK W/ CONTRAST,1333357,CDM,611,RC,70548,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI UP EXT NONJOINT W/O CONT L,1333359,CDM,610,RC,73218,HCPCS,outpatient,,,870,435,,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,334.08,38.4,,267.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,334.08,38.4,,267.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,304.5,35,,243.6,percent of total billed charges,35% of total billed charges for outpatient setting,678.6,78,,542.88,percent of total billed charges,78% of total billed charges for outpatient setting,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,652.5,75,,522,percent of total billed charges,75% of total billed charges for outpatient setting,722.1,83,,577.68,percent of total billed charges,83% of total billed charges for outpatient setting,435,50,,348,percent of total billed charges,50% of total billed charges for outpatient setting,435,50,,348,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,340.76,39.17,,272.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,722.1,
MRI UPPER EXT NONJOINT W/CONT,1333360,CDM,610,RC,73219,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI UPPER EXT JOINT W/CONT LEF,1333361,CDM,610,RC,73222,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,1093.11,
MRI LOW EXT NONJOINT W/O CONT,1333362,CDM,610,RC,73718,HCPCS,outpatient,,,2676,1338,,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,936.6,35,,749.28,percent of total billed charges,35% of total billed charges for outpatient setting,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2007,75,,1605.6,percent of total billed charges,75% of total billed charges for outpatient setting,2221.08,83,,1776.864,percent of total billed charges,83% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1048.13,39.17,,838.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,2221.08,
MRI LOW EXT NONJOINT W/CON LEF,1333363,CDM,610,RC,73719,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI LOW EXT JOINT W/CON LEFT,1333364,CDM,610,RC,73722,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,1093.11,
MRI LOW EXT JOINT W&WO CONT LE,1333365,CDM,610,RC,73723,HCPCS,outpatient,,,1124,562,,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,431.62,38.4,,345.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,431.62,38.4,,345.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,393.4,35,,314.72,percent of total billed charges,35% of total billed charges for outpatient setting,876.72,78,,701.376,percent of total billed charges,78% of total billed charges for outpatient setting,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,843,75,,674.4,percent of total billed charges,75% of total billed charges for outpatient setting,932.92,83,,746.336,percent of total billed charges,83% of total billed charges for outpatient setting,562,50,,449.6,percent of total billed charges,50% of total billed charges for outpatient setting,562,50,,449.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,440.25,39.17,,352.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,932.92,
MRI UPPER EXT JOINT W&WO CONT,1333366,CDM,610,RC,73223,HCPCS,outpatient,,,1123,561.5,,786.1,70,,628.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,431.23,38.4,,344.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,431.23,38.4,,344.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,393.05,35,,314.44,percent of total billed charges,35% of total billed charges for outpatient setting,875.94,78,,700.752,percent of total billed charges,78% of total billed charges for outpatient setting,786.1,70,,628.88,percent of total billed charges,70% of total billed charges for outpatient setting,786.1,70,,628.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,842.25,75,,673.8,percent of total billed charges,75% of total billed charges for outpatient setting,932.09,83,,745.672,percent of total billed charges,83% of total billed charges for outpatient setting,561.5,50,,449.2,percent of total billed charges,50% of total billed charges for outpatient setting,561.5,50,,449.2,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,439.85,39.17,,351.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,932.09,
MRA NECK W/ & W/O CONTRAST,1333367,CDM,611,RC,70549,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRA HEAD W/ & W/O CONTRAST,1333368,CDM,611,RC,70546,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI PELVIS W/O CONTRAST,1333369,CDM,610,RC,72195,HCPCS,outpatient,,,1910,955,,1337,70,,1069.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,733.44,38.4,,586.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,733.44,38.4,,586.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,668.5,35,,534.8,percent of total billed charges,35% of total billed charges for outpatient setting,1489.8,78,,1191.84,percent of total billed charges,78% of total billed charges for outpatient setting,1337,70,,1069.6,percent of total billed charges,70% of total billed charges for outpatient setting,1337,70,,1069.6,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1432.5,75,,1146,percent of total billed charges,75% of total billed charges for outpatient setting,1585.3,83,,1268.24,percent of total billed charges,83% of total billed charges for outpatient setting,955,50,,764,percent of total billed charges,50% of total billed charges for outpatient setting,955,50,,764,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,748.11,39.17,,598.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,1585.3,
MRI ABD W/CONTRAST,1333370,CDM,610,RC,74182,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI ABD W/ & W/O CONTRAST,1333371,CDM,610,RC,74183,HCPCS,outpatient,,,1210,605,,847,70,,677.6,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,464.64,38.4,,371.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,464.64,38.4,,371.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,423.5,35,,338.8,percent of total billed charges,35% of total billed charges for outpatient setting,943.8,78,,755.04,percent of total billed charges,78% of total billed charges for outpatient setting,847,70,,677.6,percent of total billed charges,70% of total billed charges for outpatient setting,847,70,,677.6,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,907.5,75,,726,percent of total billed charges,75% of total billed charges for outpatient setting,1004.3,83,,803.44,percent of total billed charges,83% of total billed charges for outpatient setting,605,50,,484,percent of total billed charges,50% of total billed charges for outpatient setting,605,50,,484,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.93,39.17,,379.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1004.3,
MRI LOW EXT JOINT W&WO CONT RI,1333400,CDM,610,RC,73723,HCPCS,outpatient,,,1124,562,,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,431.62,38.4,,345.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,431.62,38.4,,345.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,393.4,35,,314.72,percent of total billed charges,35% of total billed charges for outpatient setting,876.72,78,,701.376,percent of total billed charges,78% of total billed charges for outpatient setting,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,786.8,70,,629.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,843,75,,674.4,percent of total billed charges,75% of total billed charges for outpatient setting,932.92,83,,746.336,percent of total billed charges,83% of total billed charges for outpatient setting,562,50,,449.6,percent of total billed charges,50% of total billed charges for outpatient setting,562,50,,449.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,440.25,39.17,,352.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,932.92,
MRI LOW EXT JOINT W/CON RIGHT,1333401,CDM,610,RC,73722,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,1093.11,
MRI LOW EXT NONJOINT W/CON RIG,1333402,CDM,610,RC,73719,HCPCS,outpatient,,,966,483,,676.2,70,,540.96,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,370.94,38.4,,296.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,370.94,38.4,,296.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,338.1,35,,270.48,percent of total billed charges,35% of total billed charges for outpatient setting,753.48,78,,602.784,percent of total billed charges,78% of total billed charges for outpatient setting,676.2,70,,540.96,percent of total billed charges,70% of total billed charges for outpatient setting,676.2,70,,540.96,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,724.5,75,,579.6,percent of total billed charges,75% of total billed charges for outpatient setting,801.78,83,,641.424,percent of total billed charges,83% of total billed charges for outpatient setting,483,50,,386.4,percent of total billed charges,50% of total billed charges for outpatient setting,483,50,,386.4,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,378.36,39.17,,302.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,801.78,
MRI LOW EXT NONJOINT W/O CONT,1333403,CDM,610,RC,73718,HCPCS,outpatient,,,2676,1338,,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,936.6,35,,749.28,percent of total billed charges,35% of total billed charges for outpatient setting,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2007,75,,1605.6,percent of total billed charges,75% of total billed charges for outpatient setting,2221.08,83,,1776.864,percent of total billed charges,83% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1048.13,39.17,,838.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,2221.08,
MRI LOWER EXT ANGIO RIGHT,1333404,CDM,610,RC,73725,HCPCS,outpatient,,,958,479,,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,335.3,35,,268.24,percent of total billed charges,35% of total billed charges for outpatient setting,747.24,78,,597.792,percent of total billed charges,78% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,718.5,75,,574.8,percent of total billed charges,75% of total billed charges for outpatient setting,795.14,83,,636.112,percent of total billed charges,83% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.23,39.17,,300.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,335.3,795.14,
MRI LOWER EXT JOINT W/O CONT R,1333405,CDM,610,RC,73721,HCPCS,outpatient,,,3746.4,1873.2,,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1438.62,38.4,,1150.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1311.24,35,,1048.992,percent of total billed charges,35% of total billed charges for outpatient setting,2922.19,78,,2337.752,percent of total billed charges,78% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,2622.48,70,,2097.984,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2809.8,75,,2247.84,percent of total billed charges,75% of total billed charges for outpatient setting,3109.51,83,,2487.608,percent of total billed charges,83% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,1873.2,50,,1498.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1467.39,39.17,,1173.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,3109.51,
MRI LOWER EXT NON-JOINT W&WO C,1333406,CDM,610,RC,73720,HCPCS,outpatient,,,1198,599,,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,460.03,38.4,,368.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,460.03,38.4,,368.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,419.3,35,,335.44,percent of total billed charges,35% of total billed charges for outpatient setting,934.44,78,,747.552,percent of total billed charges,78% of total billed charges for outpatient setting,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,838.6,70,,670.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.5,75,,718.8,percent of total billed charges,75% of total billed charges for outpatient setting,994.34,83,,795.472,percent of total billed charges,83% of total billed charges for outpatient setting,599,50,,479.2,percent of total billed charges,50% of total billed charges for outpatient setting,599,50,,479.2,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,469.23,39.17,,375.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,994.34,
MRI LOWER EXT W/WO C ANGIO RIG,1333407,CDM,610,RC,73725,HCPCS,outpatient,,,1246,623,,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,478.46,38.4,,382.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,478.46,38.4,,382.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,436.1,35,,348.88,percent of total billed charges,35% of total billed charges for outpatient setting,971.88,78,,777.504,percent of total billed charges,78% of total billed charges for outpatient setting,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.5,75,,747.6,percent of total billed charges,75% of total billed charges for outpatient setting,1034.18,83,,827.344,percent of total billed charges,83% of total billed charges for outpatient setting,623,50,,498.4,percent of total billed charges,50% of total billed charges for outpatient setting,623,50,,498.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,488.03,39.17,,390.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,436.1,1034.18,
MRI UPPER EXT JOINT W&WO CONT,1333409,CDM,610,RC,73223,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
MRI UPPER EXT JOINT W/CONT RIG,1333410,CDM,610,RC,73222,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,1093.11,
MRI UPPER EXT NONJOINT W/CONT,1333411,CDM,610,RC,73219,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI UP EXT NONJOINT W/O CONT R,1333412,CDM,610,RC,73218,HCPCS,outpatient,,,870,435,,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,334.08,38.4,,267.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,334.08,38.4,,267.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,304.5,35,,243.6,percent of total billed charges,35% of total billed charges for outpatient setting,678.6,78,,542.88,percent of total billed charges,78% of total billed charges for outpatient setting,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,609,70,,487.2,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,652.5,75,,522,percent of total billed charges,75% of total billed charges for outpatient setting,722.1,83,,577.68,percent of total billed charges,83% of total billed charges for outpatient setting,435,50,,348,percent of total billed charges,50% of total billed charges for outpatient setting,435,50,,348,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,340.76,39.17,,272.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,722.1,
MRI UPPER JOINT W/O CONT RIGHT,1333413,CDM,610,RC,73221,HCPCS,outpatient,,,2676,1338,,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1027.58,38.4,,822.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,936.6,35,,749.28,percent of total billed charges,35% of total billed charges for outpatient setting,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,1873.2,70,,1498.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2007,75,,1605.6,percent of total billed charges,75% of total billed charges for outpatient setting,2221.08,83,,1776.864,percent of total billed charges,83% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,1338,50,,1070.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1048.13,39.17,,838.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,2221.08,
MRI UPPER EXT W&WO NONJT RIGHT,1333414,CDM,610,RC,73220,HCPCS,outpatient,,,1522,761,,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,584.45,38.4,,467.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532.7,35,,426.16,percent of total billed charges,35% of total billed charges for outpatient setting,1187.16,78,,949.728,percent of total billed charges,78% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,1065.4,70,,852.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1141.5,75,,913.2,percent of total billed charges,75% of total billed charges for outpatient setting,1263.26,83,,1010.608,percent of total billed charges,83% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,761,50,,608.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.14,39.17,,476.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1263.26,
OPTIMARK GADOLINIUM,1356907,CDM,636,RC,A9579,HCPCS,both,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
MRI LOWER EXT W OR W/O C ANGIO,1380007,CDM,610,RC,73725,HCPCS,outpatient,,,1246,623,,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,478.46,38.4,,382.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,478.46,38.4,,382.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,436.1,35,,348.88,percent of total billed charges,35% of total billed charges for outpatient setting,971.88,78,,777.504,percent of total billed charges,78% of total billed charges for outpatient setting,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,872.2,70,,697.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.5,75,,747.6,percent of total billed charges,75% of total billed charges for outpatient setting,1034.18,83,,827.344,percent of total billed charges,83% of total billed charges for outpatient setting,623,50,,498.4,percent of total billed charges,50% of total billed charges for outpatient setting,623,50,,498.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,488.03,39.17,,390.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,436.1,1034.18,
MRI ORBIT FACE AND NECK W/C,1380028,CDM,610,RC,70542,HCPCS,outpatient,,,1317,658.5,,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,505.73,38.4,,404.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.95,35,,368.76,percent of total billed charges,35% of total billed charges for outpatient setting,1027.26,78,,821.808,percent of total billed charges,78% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,921.9,70,,737.52,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.75,75,,790.2,percent of total billed charges,75% of total billed charges for outpatient setting,1093.11,83,,874.488,percent of total billed charges,83% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,658.5,50,,526.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.84,39.17,,412.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1093.11,
MRI ORBIT FACE AND NECK W&W,1380029,CDM,610,RC,70543,HCPCS,outpatient,,,2132,1066,,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,818.69,38.4,,654.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,818.69,38.4,,654.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,746.2,35,,596.96,percent of total billed charges,35% of total billed charges for outpatient setting,1662.96,78,,1330.368,percent of total billed charges,78% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,1492.4,70,,1193.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1599,75,,1279.2,percent of total billed charges,75% of total billed charges for outpatient setting,1769.56,83,,1415.648,percent of total billed charges,83% of total billed charges for outpatient setting,1066,50,,852.8,percent of total billed charges,50% of total billed charges for outpatient setting,1066,50,,852.8,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,835.06,39.17,,668.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1769.56,
MRI PELVIS W&WO CONTRAST,1380030,CDM,610,RC,72197,HCPCS,outpatient,,,4476,2238,,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1718.78,38.4,,1375.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1718.78,38.4,,1375.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.6,35,,1253.28,percent of total billed charges,35% of total billed charges for outpatient setting,3491.28,78,,2793.024,percent of total billed charges,78% of total billed charges for outpatient setting,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,3133.2,70,,2506.56,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3357,75,,2685.6,percent of total billed charges,75% of total billed charges for outpatient setting,3715.08,83,,2972.064,percent of total billed charges,83% of total billed charges for outpatient setting,2238,50,,1790.4,percent of total billed charges,50% of total billed charges for outpatient setting,2238,50,,1790.4,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1753.16,39.17,,1402.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,3715.08,
MRA PELVIS WITH OR WO CONTRAST,1380031,CDM,610,RC,72198,HCPCS,outpatient,,,958,479,,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.87,38.4,,294.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,600,100,,,case rate,100% Anthem MRI case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,335.3,35,,268.24,percent of total billed charges,35% of total billed charges for outpatient setting,747.24,78,,597.792,percent of total billed charges,78% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,670.6,70,,536.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,718.5,75,,574.8,percent of total billed charges,75% of total billed charges for outpatient setting,795.14,83,,636.112,percent of total billed charges,83% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,479,50,,383.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.23,39.17,,300.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,335.3,795.14,
CONTRAST EOVIST,1388931,CDM,636,RC,A9581,HCPCS,both,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
US ABD COMPLETE,1400000,CDM,402,RC,76700,HCPCS,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1825.6,
US ABD (SPECIFY OR,1400001,CDM,402,RC,76705,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
US RENAL TRANSPLANT,1400002,CDM,402,RC,76776,HCPCS,outpatient,,,378,189,,264.6,70,,211.68,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,145.15,38.4,,116.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.15,38.4,,116.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,232.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.3,35,,105.84,percent of total billed charges,35% of total billed charges for outpatient setting,294.84,78,,235.872,percent of total billed charges,78% of total billed charges for outpatient setting,264.6,70,,211.68,percent of total billed charges,70% of total billed charges for outpatient setting,264.6,70,,211.68,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,283.5,75,,226.8,percent of total billed charges,75% of total billed charges for outpatient setting,313.74,83,,250.992,percent of total billed charges,83% of total billed charges for outpatient setting,604.8,100,,,case rate,100% UHC case rate for outpatient setting,604.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,148.05,39.17,,118.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,604.8,
US PELVIC GENERAL,1400003,CDM,402,RC,76856,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,148.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1304,
US RETROPERITONEUM,1400004,CDM,402,RC,76770,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,149.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
US THYROID,1400005,CDM,402,RC,76536,HCPCS,outpatient,,,392,196,,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.2,35,,109.76,percent of total billed charges,35% of total billed charges for outpatient setting,305.76,78,,244.608,percent of total billed charges,78% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,325.36,83,,260.288,percent of total billed charges,83% of total billed charges for outpatient setting,627.2,100,,,case rate,100% UHC case rate for outpatient setting,627.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.54,39.17,,122.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,627.2,
US TESTICLE,1400006,CDM,402,RC,76870,HCPCS,outpatient,,,582,291,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,70.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.7,35,,162.96,percent of total billed charges,35% of total billed charges for outpatient setting,453.96,78,,363.168,percent of total billed charges,78% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,436.5,75,,349.2,percent of total billed charges,75% of total billed charges for outpatient setting,483.06,83,,386.448,percent of total billed charges,83% of total billed charges for outpatient setting,931.2,100,,,case rate,100% UHC case rate for outpatient setting,931.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.96,39.17,,182.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.11,931.2,
US TRANSRECTAL,1400007,CDM,402,RC,76872,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,122.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
US TRANSVAGINAL,1400008,CDM,402,RC,76830,HCPCS,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1825.6,
US GUIDE THORANCENTE,1400009,CDM,402,RC,76942,HCPCS,outpatient,,,556,278,,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.6,35,,155.68,percent of total billed charges,35% of total billed charges for outpatient setting,433.68,78,,346.944,percent of total billed charges,78% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,461.48,83,,369.184,percent of total billed charges,83% of total billed charges for outpatient setting,889.6,100,,,case rate,100% UHC case rate for outpatient setting,889.6,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.77,39.17,,174.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.66,889.6,
US PELVIS OB GREATER THAN 14,1400015,CDM,402,RC,76805,HCPCS,outpatient,,,582,291,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,179.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.7,35,,162.96,percent of total billed charges,35% of total billed charges for outpatient setting,453.96,78,,363.168,percent of total billed charges,78% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,436.5,75,,349.2,percent of total billed charges,75% of total billed charges for outpatient setting,483.06,83,,386.448,percent of total billed charges,83% of total billed charges for outpatient setting,931.2,100,,,case rate,100% UHC case rate for outpatient setting,931.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.96,39.17,,182.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,931.2,
NM LYMPHOSCINTIGRAM,1400016,CDM,341,RC,78195,HCPCS,outpatient,,,877,438.5,,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,336.77,38.4,,269.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336.77,38.4,,269.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.95,35,,245.56,percent of total billed charges,35% of total billed charges for outpatient setting,684.06,78,,547.248,percent of total billed charges,78% of total billed charges for outpatient setting,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,657.75,75,,526.2,percent of total billed charges,75% of total billed charges for outpatient setting,727.91,83,,582.328,percent of total billed charges,83% of total billed charges for outpatient setting,1403.2,100,,,case rate,100% UHC case rate for outpatient setting,1403.2,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,343.51,39.17,,274.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.95,1403.2,
CTA AORTA/ILIOFEMORAL/LE W&WO,1400017,CDM,352,RC,75635,HCPCS,outpatient,,,919,459.5,,643.3,70,,514.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,352.9,38.4,,282.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,352.9,38.4,,282.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,321.65,35,,257.32,percent of total billed charges,35% of total billed charges for outpatient setting,716.82,78,,573.456,percent of total billed charges,78% of total billed charges for outpatient setting,643.3,70,,514.64,percent of total billed charges,70% of total billed charges for outpatient setting,643.3,70,,514.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,689.25,75,,551.4,percent of total billed charges,75% of total billed charges for outpatient setting,762.77,83,,610.216,percent of total billed charges,83% of total billed charges for outpatient setting,1470.4,100,,,case rate,100% UHC case rate for outpatient setting,1470.4,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,359.96,39.17,,287.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1470.4,
CTA-LOWER EXT. W&WO,1400018,CDM,352,RC,73706,HCPCS,outpatient,,,853,426.5,,597.1,70,,477.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,327.55,38.4,,262.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,327.55,38.4,,262.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,298.55,35,,238.84,percent of total billed charges,35% of total billed charges for outpatient setting,665.34,78,,532.272,percent of total billed charges,78% of total billed charges for outpatient setting,597.1,70,,477.68,percent of total billed charges,70% of total billed charges for outpatient setting,597.1,70,,477.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,639.75,75,,511.8,percent of total billed charges,75% of total billed charges for outpatient setting,707.99,83,,566.392,percent of total billed charges,83% of total billed charges for outpatient setting,1364.8,100,,,case rate,100% UHC case rate for outpatient setting,1364.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,334.1,39.17,,267.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1364.8,
US OB LESS THAN 14WKS,1400021,CDM,402,RC,76801,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.22,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1304,
US OB LIMITED,1400022,CDM,402,RC,76815,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,332.8,100,,,case rate,100% UHC case rate for outpatient setting,332.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.8,332.8,
US OB FLU,1400023,CDM,402,RC,76816,HCPCS,outpatient,,,283,141.5,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,140.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.05,35,,79.24,percent of total billed charges,35% of total billed charges for outpatient setting,220.74,78,,176.592,percent of total billed charges,78% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,234.89,83,,187.912,percent of total billed charges,83% of total billed charges for outpatient setting,452.8,100,,,case rate,100% UHC case rate for outpatient setting,452.8,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.84,39.17,,88.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,452.8,
US OB TRANSVAGINAL,1400024,CDM,402,RC,76817,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1304,
US FETAL BPP W/NON-STRESS,1400025,CDM,402,RC,76818,HCPCS,outpatient,,,304,152,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,135.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.4,35,,85.12,percent of total billed charges,35% of total billed charges for outpatient setting,237.12,78,,189.696,percent of total billed charges,78% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,252.32,83,,201.856,percent of total billed charges,83% of total billed charges for outpatient setting,486.4,100,,,case rate,100% UHC case rate for outpatient setting,486.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.07,39.17,,95.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,486.4,
US FETAL BPP W/O NON-STRESS,1400026,CDM,402,RC,76819,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
CTA ABDOMEN,1400027,CDM,352,RC,74175,HCPCS,outpatient,,,3155,1577.5,,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1211.52,38.4,,969.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1211.52,38.4,,969.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1104.25,35,,883.4,percent of total billed charges,35% of total billed charges for outpatient setting,2460.9,78,,1968.72,percent of total billed charges,78% of total billed charges for outpatient setting,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2366.25,75,,1893,percent of total billed charges,75% of total billed charges for outpatient setting,2618.65,83,,2094.92,percent of total billed charges,83% of total billed charges for outpatient setting,5048,100,,,case rate,100% UHC case rate for outpatient setting,5048,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1235.75,39.17,,988.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,5048,
NM MYOVIEW,1400028,CDM,636,RC,A9500,HCPCS,both,,,156.98,78.49,,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.28,38.4,,48.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.28,38.4,,48.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,117.74,75,,94.192,percent of total billed charges,75% of total billed charges for outpatient setting,117.74,75,,94.192,percent of total billed charges,75% of total billed charges for outpatient setting,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,117.74,75,,94.192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.94,35,,43.952,percent of total billed charges,35% of total billed charges for outpatient setting,122.44,78,,97.952,percent of total billed charges,78% of total billed charges for outpatient setting,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,109.89,70,,87.912,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.74,75,,94.192,percent of total billed charges,75% of total billed charges for outpatient setting,130.29,83,,104.232,percent of total billed charges,83% of total billed charges for outpatient setting,78.49,50,,62.792,percent of total billed charges,50% of total billed charges for outpatient setting,78.49,50,,62.792,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.49,39.17,,49.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.94,130.29,
CTA HEAD,1400029,CDM,352,RC,70496,HCPCS,outpatient,,,3155,1577.5,,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1211.52,38.4,,969.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1211.52,38.4,,969.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1104.25,35,,883.4,percent of total billed charges,35% of total billed charges for outpatient setting,2460.9,78,,1968.72,percent of total billed charges,78% of total billed charges for outpatient setting,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,2208.5,70,,1766.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2366.25,75,,1893,percent of total billed charges,75% of total billed charges for outpatient setting,2618.65,83,,2094.92,percent of total billed charges,83% of total billed charges for outpatient setting,5048,100,,,case rate,100% UHC case rate for outpatient setting,5048,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1235.75,39.17,,988.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,5048,
CTA NECK,1400030,CDM,352,RC,70498,HCPCS,outpatient,,,4417,2208.5,,3091.9,70,,2473.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1696.13,38.4,,1356.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1696.13,38.4,,1356.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1545.95,35,,1236.76,percent of total billed charges,35% of total billed charges for outpatient setting,3445.26,78,,2756.208,percent of total billed charges,78% of total billed charges for outpatient setting,3091.9,70,,2473.52,percent of total billed charges,70% of total billed charges for outpatient setting,3091.9,70,,2473.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3312.75,75,,2650.2,percent of total billed charges,75% of total billed charges for outpatient setting,3666.11,83,,2932.888,percent of total billed charges,83% of total billed charges for outpatient setting,7067.2,100,,,case rate,100% UHC case rate for outpatient setting,7067.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1730.05,39.17,,1384.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,7067.2,
CTA PELVIS,1400031,CDM,352,RC,72191,HCPCS,outpatient,,,1503,751.5,,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,577.15,38.4,,461.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,577.15,38.4,,461.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,526.05,35,,420.84,percent of total billed charges,35% of total billed charges for outpatient setting,1172.34,78,,937.872,percent of total billed charges,78% of total billed charges for outpatient setting,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1127.25,75,,901.8,percent of total billed charges,75% of total billed charges for outpatient setting,1247.49,83,,997.992,percent of total billed charges,83% of total billed charges for outpatient setting,2404.8,100,,,case rate,100% UHC case rate for outpatient setting,2404.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,588.69,39.17,,470.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2404.8,
CTA UPPER EXTREMITY,1400032,CDM,352,RC,73206,HCPCS,outpatient,,,1503,751.5,,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,577.15,38.4,,461.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,577.15,38.4,,461.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,526.05,35,,420.84,percent of total billed charges,35% of total billed charges for outpatient setting,1172.34,78,,937.872,percent of total billed charges,78% of total billed charges for outpatient setting,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,1052.1,70,,841.68,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1127.25,75,,901.8,percent of total billed charges,75% of total billed charges for outpatient setting,1247.49,83,,997.992,percent of total billed charges,83% of total billed charges for outpatient setting,2404.8,100,,,case rate,100% UHC case rate for outpatient setting,2404.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,588.69,39.17,,470.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2404.8,
CT C SPINE W/WO CONTRAST,1400033,CDM,352,RC,72127,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
NM QUANTATIVE PUL PERFUSION,1400035,CDM,341,RC,78597,HCPCS,outpatient,,,498,249,,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,339.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,35,,139.44,percent of total billed charges,35% of total billed charges for outpatient setting,388.44,78,,310.752,percent of total billed charges,78% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,373.5,75,,298.8,percent of total billed charges,75% of total billed charges for outpatient setting,413.34,83,,330.672,percent of total billed charges,83% of total billed charges for outpatient setting,796.8,100,,,case rate,100% UHC case rate for outpatient setting,796.8,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.05,39.17,,156.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,796.8,
NM QUANTATIVE PUL VENT/PERF,1400036,CDM,341,RC,78598,HCPCS,outpatient,,,1863,931.5,,1304.1,70,,1043.28,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,715.39,38.4,,572.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,715.39,38.4,,572.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,533.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,652.05,35,,521.64,percent of total billed charges,35% of total billed charges for outpatient setting,1453.14,78,,1162.512,percent of total billed charges,78% of total billed charges for outpatient setting,1304.1,70,,1043.28,percent of total billed charges,70% of total billed charges for outpatient setting,1304.1,70,,1043.28,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1397.25,75,,1117.8,percent of total billed charges,75% of total billed charges for outpatient setting,1546.29,83,,1237.032,percent of total billed charges,83% of total billed charges for outpatient setting,2980.8,100,,,case rate,100% UHC case rate for outpatient setting,2980.8,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,729.7,39.17,,583.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,2980.8,
NM HIDA W/EF,1400037,CDM,341,RC,78227,HCPCS,outpatient,,,2254,1127,,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,865.54,38.4,,692.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,865.54,38.4,,692.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,816.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,788.9,35,,631.12,percent of total billed charges,35% of total billed charges for outpatient setting,1758.12,78,,1406.496,percent of total billed charges,78% of total billed charges for outpatient setting,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,75,,1352.4,percent of total billed charges,75% of total billed charges for outpatient setting,1870.82,83,,1496.656,percent of total billed charges,83% of total billed charges for outpatient setting,3606.4,100,,,case rate,100% UHC case rate for outpatient setting,3606.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,882.85,39.17,,706.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,3606.4,
NM HIDA IMAGING ONLY,1400038,CDM,341,RC,78226,HCPCS,outpatient,,,2254,1127,,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,865.54,38.4,,692.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,865.54,38.4,,692.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,595.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,788.9,35,,631.12,percent of total billed charges,35% of total billed charges for outpatient setting,1758.12,78,,1406.496,percent of total billed charges,78% of total billed charges for outpatient setting,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,1577.8,70,,1262.24,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,75,,1352.4,percent of total billed charges,75% of total billed charges for outpatient setting,1870.82,83,,1496.656,percent of total billed charges,83% of total billed charges for outpatient setting,3606.4,100,,,case rate,100% UHC case rate for outpatient setting,3606.4,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,882.85,39.17,,706.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,3606.4,
CTA CHEST,1400048,CDM,352,RC,71275,HCPCS,outpatient,,,752,376,,526.4,70,,421.12,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,288.77,38.4,,231.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288.77,38.4,,231.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,263.2,35,,210.56,percent of total billed charges,35% of total billed charges for outpatient setting,586.56,78,,469.248,percent of total billed charges,78% of total billed charges for outpatient setting,526.4,70,,421.12,percent of total billed charges,70% of total billed charges for outpatient setting,526.4,70,,421.12,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,564,75,,451.2,percent of total billed charges,75% of total billed charges for outpatient setting,624.16,83,,499.328,percent of total billed charges,83% of total billed charges for outpatient setting,1203.2,100,,,case rate,100% UHC case rate for outpatient setting,1203.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,294.55,39.17,,235.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1203.2,
US BREAST LIMITED,1400050,CDM,402,RC,76642,HCPCS,outpatient,,,216,108,,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,82.94,38.4,,66.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.94,38.4,,66.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,105.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,35,,60.48,percent of total billed charges,35% of total billed charges for outpatient setting,168.48,78,,134.784,percent of total billed charges,78% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.28,83,,143.424,percent of total billed charges,83% of total billed charges for outpatient setting,345.6,100,,,case rate,100% UHC case rate for outpatient setting,345.6,100,,,case rate,100% UHC case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.6,39.17,,67.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,345.6,
CTA ABD/PELVIS,1400053,CDM,352,RC,74174,HCPCS,outpatient,,,968,484,,677.6,70,,542.08,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,371.71,38.4,,297.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,371.71,38.4,,297.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,338.8,35,,271.04,percent of total billed charges,35% of total billed charges for outpatient setting,755.04,78,,604.032,percent of total billed charges,78% of total billed charges for outpatient setting,677.6,70,,542.08,percent of total billed charges,70% of total billed charges for outpatient setting,677.6,70,,542.08,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,726,75,,580.8,percent of total billed charges,75% of total billed charges for outpatient setting,803.44,83,,642.752,percent of total billed charges,83% of total billed charges for outpatient setting,1548.8,100,,,case rate,100% UHC case rate for outpatient setting,1548.8,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,379.14,39.17,,303.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,1548.8,
US AORTA SCREENING,1400057,CDM,402,RC,76706,HCPCS,outpatient,,,227,113.5,,158.9,70,,127.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,87.17,38.4,,69.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.17,38.4,,69.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,130.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.45,35,,63.56,percent of total billed charges,35% of total billed charges for outpatient setting,177.06,78,,141.648,percent of total billed charges,78% of total billed charges for outpatient setting,158.9,70,,127.12,percent of total billed charges,70% of total billed charges for outpatient setting,158.9,70,,127.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.25,75,,136.2,percent of total billed charges,75% of total billed charges for outpatient setting,188.41,83,,150.728,percent of total billed charges,83% of total billed charges for outpatient setting,363.2,100,,,case rate,100% UHC case rate for outpatient setting,363.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.91,39.17,,71.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.45,363.2,
US ABD LIVER,1410063,CDM,320,RC,76705,HCPCS,outpatient,,,582,291,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.7,35,,162.96,percent of total billed charges,35% of total billed charges for outpatient setting,453.96,78,,363.168,percent of total billed charges,78% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,436.5,75,,349.2,percent of total billed charges,75% of total billed charges for outpatient setting,483.06,83,,386.448,percent of total billed charges,83% of total billed charges for outpatient setting,291,50,,232.8,percent of total billed charges,50% of total billed charges for outpatient setting,291,50,,232.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.96,39.17,,182.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,483.06,
US ABD-BILIARY TR,1410114,CDM,320,RC,76705,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,407.5,50,,326,percent of total billed charges,50% of total billed charges for outpatient setting,407.5,50,,326,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,676.45,
CT NECK W/O CONTRAST,1410118,CDM,352,RC,70490,HCPCS,outpatient,,,466,233,,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.94,38.4,,143.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.1,35,,130.48,percent of total billed charges,35% of total billed charges for outpatient setting,363.48,78,,290.784,percent of total billed charges,78% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,326.2,70,,260.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,349.5,75,,279.6,percent of total billed charges,75% of total billed charges for outpatient setting,386.78,83,,309.424,percent of total billed charges,83% of total billed charges for outpatient setting,745.6,100,,,case rate,100% UHC case rate for outpatient setting,745.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.52,39.17,,146.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,745.6,
CT BRAIN W-W/O CONTR,1410120,CDM,351,RC,70470,HCPCS,outpatient,,,939,469.5,,657.3,70,,525.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,360.58,38.4,,288.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,360.58,38.4,,288.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,328.65,35,,262.92,percent of total billed charges,35% of total billed charges for outpatient setting,732.42,78,,585.936,percent of total billed charges,78% of total billed charges for outpatient setting,657.3,70,,525.84,percent of total billed charges,70% of total billed charges for outpatient setting,657.3,70,,525.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,704.25,75,,563.4,percent of total billed charges,75% of total billed charges for outpatient setting,779.37,83,,623.496,percent of total billed charges,83% of total billed charges for outpatient setting,1502.4,100,,,case rate,100% UHC case rate for outpatient setting,1502.4,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,367.79,39.17,,294.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1502.4,
US ABD SURVEY,1410143,CDM,320,RC,76700,HCPCS,outpatient,,,297,148.5,,207.9,70,,166.32,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,114.05,38.4,,91.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.05,38.4,,91.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.95,35,,83.16,percent of total billed charges,35% of total billed charges for outpatient setting,231.66,78,,185.328,percent of total billed charges,78% of total billed charges for outpatient setting,207.9,70,,166.32,percent of total billed charges,70% of total billed charges for outpatient setting,207.9,70,,166.32,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,222.75,75,,178.2,percent of total billed charges,75% of total billed charges for outpatient setting,246.51,83,,197.208,percent of total billed charges,83% of total billed charges for outpatient setting,148.5,50,,118.8,percent of total billed charges,50% of total billed charges for outpatient setting,148.5,50,,118.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.33,39.17,,93.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,246.51,
CT NECK W/CON,1410193,CDM,352,RC,70491,HCPCS,outpatient,,,3767,1883.5,,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1318.45,35,,1054.76,percent of total billed charges,35% of total billed charges for outpatient setting,2938.26,78,,2350.608,percent of total billed charges,78% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2825.25,75,,2260.2,percent of total billed charges,75% of total billed charges for outpatient setting,3126.61,83,,2501.288,percent of total billed charges,83% of total billed charges for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1475.46,39.17,,1180.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,6027.2,
CT UPPER EXT W/CON LEFT,1410452,CDM,352,RC,73201,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,2051.2,
CT UPPER EXT WO/CON LEFT,1410453,CDM,352,RC,73200,HCPCS,outpatient,,,456,228,,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.6,35,,127.68,percent of total billed charges,35% of total billed charges for outpatient setting,355.68,78,,284.544,percent of total billed charges,78% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,378.48,83,,302.784,percent of total billed charges,83% of total billed charges for outpatient setting,729.6,100,,,case rate,100% UHC case rate for outpatient setting,729.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.6,39.17,,142.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,729.6,
CT LOWER EXT W/O CON LEFT,1410454,CDM,352,RC,73700,HCPCS,outpatient,,,432,216,,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.2,35,,120.96,percent of total billed charges,35% of total billed charges for outpatient setting,336.96,78,,269.568,percent of total billed charges,78% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,358.56,83,,286.848,percent of total billed charges,83% of total billed charges for outpatient setting,691.2,100,,,case rate,100% UHC case rate for outpatient setting,691.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.21,39.17,,135.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,691.2,
CT LOWER EXT W/CONT LEFT,1410455,CDM,352,RC,73701,HCPCS,outpatient,,,1794,897,,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,627.9,35,,502.32,percent of total billed charges,35% of total billed charges for outpatient setting,1399.32,78,,1119.456,percent of total billed charges,78% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1345.5,75,,1076.4,percent of total billed charges,75% of total billed charges for outpatient setting,1489.02,83,,1191.216,percent of total billed charges,83% of total billed charges for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,702.68,39.17,,562.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2870.4,
CT LOWER EXT W&WO CO LEFT,1410456,CDM,352,RC,73702,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
CT LUMBAR SPINE W/CO,1410457,CDM,352,RC,72132,HCPCS,outpatient,,,898,449,,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,314.3,35,,251.44,percent of total billed charges,35% of total billed charges for outpatient setting,700.44,78,,560.352,percent of total billed charges,78% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,673.5,75,,538.8,percent of total billed charges,75% of total billed charges for outpatient setting,745.34,83,,596.272,percent of total billed charges,83% of total billed charges for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.73,39.17,,281.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,314.3,1436.8,
CT L SPINE W&WO CON,1410458,CDM,352,RC,72133,HCPCS,outpatient,,,722,361,,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.7,35,,202.16,percent of total billed charges,35% of total billed charges for outpatient setting,563.16,78,,450.528,percent of total billed charges,78% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,541.5,75,,433.2,percent of total billed charges,75% of total billed charges for outpatient setting,599.26,83,,479.408,percent of total billed charges,83% of total billed charges for outpatient setting,1155.2,100,,,case rate,100% UHC case rate for outpatient setting,1155.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,282.8,39.17,,226.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1155.2,
CT NECK W&WO CON,1410460,CDM,352,RC,70492,HCPCS,outpatient,,,1011,505.5,,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,353.85,35,,283.08,percent of total billed charges,35% of total billed charges for outpatient setting,788.58,78,,630.864,percent of total billed charges,78% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,839.13,83,,671.304,percent of total billed charges,83% of total billed charges for outpatient setting,1617.6,100,,,case rate,100% UHC case rate for outpatient setting,1617.6,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,395.98,39.17,,316.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1617.6,
CT FACIAL W/O CON,1410461,CDM,351,RC,70486,HCPCS,outpatient,,,384.86,192.43,,269.4,70,,215.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,147.79,38.4,,118.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147.79,38.4,,118.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.7,35,,107.76,percent of total billed charges,35% of total billed charges for outpatient setting,300.19,78,,240.152,percent of total billed charges,78% of total billed charges for outpatient setting,269.4,70,,215.52,percent of total billed charges,70% of total billed charges for outpatient setting,269.4,70,,215.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,288.65,75,,230.92,percent of total billed charges,75% of total billed charges for outpatient setting,319.43,83,,255.544,percent of total billed charges,83% of total billed charges for outpatient setting,615.78,100,,,case rate,100% UHC case rate for outpatient setting,615.78,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,150.75,39.17,,120.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,615.78,
CT FACIAL W/CON,1410462,CDM,351,RC,70487,HCPCS,outpatient,,,898,449,,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,314.3,35,,251.44,percent of total billed charges,35% of total billed charges for outpatient setting,700.44,78,,560.352,percent of total billed charges,78% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,673.5,75,,538.8,percent of total billed charges,75% of total billed charges for outpatient setting,745.34,83,,596.272,percent of total billed charges,83% of total billed charges for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.73,39.17,,281.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1436.8,
CT FACIAL W&WO CON,1410463,CDM,351,RC,70488,HCPCS,outpatient,,,1011,505.5,,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,353.85,35,,283.08,percent of total billed charges,35% of total billed charges for outpatient setting,788.58,78,,630.864,percent of total billed charges,78% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,839.13,83,,671.304,percent of total billed charges,83% of total billed charges for outpatient setting,1617.6,100,,,case rate,100% UHC case rate for outpatient setting,1617.6,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,395.98,39.17,,316.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1617.6,
CT PELVIS W&WO CON,1410464,CDM,352,RC,72194,HCPCS,outpatient,,,722,361,,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,277.25,38.4,,221.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.7,35,,202.16,percent of total billed charges,35% of total billed charges for outpatient setting,563.16,78,,450.528,percent of total billed charges,78% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,505.4,70,,404.32,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,541.5,75,,433.2,percent of total billed charges,75% of total billed charges for outpatient setting,599.26,83,,479.408,percent of total billed charges,83% of total billed charges for outpatient setting,1155.2,100,,,case rate,100% UHC case rate for outpatient setting,1155.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,282.8,39.17,,226.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1155.2,
CT THORA-SPINE W/CON,1410465,CDM,352,RC,72129,HCPCS,outpatient,,,1794,897,,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,627.9,35,,502.32,percent of total billed charges,35% of total billed charges for outpatient setting,1399.32,78,,1119.456,percent of total billed charges,78% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1345.5,75,,1076.4,percent of total billed charges,75% of total billed charges for outpatient setting,1489.02,83,,1191.216,percent of total billed charges,83% of total billed charges for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,702.68,39.17,,562.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2870.4,
CT T-SPINE W&WO CON,1410466,CDM,352,RC,72130,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
CT GUIDE NEEDLE BIOP,1410468,CDM,359,RC,77012,HCPCS,outpatient,,,507,253.5,,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.69,38.4,,155.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.69,38.4,,155.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177.45,35,,141.96,percent of total billed charges,35% of total billed charges for outpatient setting,395.46,78,,316.368,percent of total billed charges,78% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,380.25,75,,304.2,percent of total billed charges,75% of total billed charges for outpatient setting,420.81,83,,336.648,percent of total billed charges,83% of total billed charges for outpatient setting,811.2,100,,,case rate,100% UHC case rate for outpatient setting,811.2,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,198.58,39.17,,158.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,177.45,811.2,
CT GUIDE CYST ASPIRA,1410469,CDM,359,RC,77012,HCPCS,outpatient,,,723,361.5,,506.1,70,,404.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.63,38.4,,222.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,277.63,38.4,,222.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,253.05,35,,202.44,percent of total billed charges,35% of total billed charges for outpatient setting,563.94,78,,451.152,percent of total billed charges,78% of total billed charges for outpatient setting,506.1,70,,404.88,percent of total billed charges,70% of total billed charges for outpatient setting,506.1,70,,404.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,542.25,75,,433.8,percent of total billed charges,75% of total billed charges for outpatient setting,600.09,83,,480.072,percent of total billed charges,83% of total billed charges for outpatient setting,1156.8,100,,,case rate,100% UHC case rate for outpatient setting,1156.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,283.18,39.17,,226.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,253.05,1156.8,
NM THYROIS SCAN/UPTAKE,1410478,CDM,341,RC,78014,HCPCS,outpatient,,,1737,868.5,,1215.9,70,,972.72,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,667.01,38.4,,533.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,667.01,38.4,,533.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,438.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,607.95,35,,486.36,percent of total billed charges,35% of total billed charges for outpatient setting,1354.86,78,,1083.888,percent of total billed charges,78% of total billed charges for outpatient setting,1215.9,70,,972.72,percent of total billed charges,70% of total billed charges for outpatient setting,1215.9,70,,972.72,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1302.75,75,,1042.2,percent of total billed charges,75% of total billed charges for outpatient setting,1441.71,83,,1153.368,percent of total billed charges,83% of total billed charges for outpatient setting,2779.2,100,,,case rate,100% UHC case rate for outpatient setting,2779.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,680.35,39.17,,544.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,2779.2,
US GUIDE NEEDLE BIOP,1410497,CDM,402,RC,76942,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,267.2,100,,,case rate,100% UHC case rate for outpatient setting,267.2,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.66,267.2,
US LOWER EXT ART BILATERAL,1410499,CDM,921,RC,93925,HCPCS,outpatient,,,835.56,417.78,,584.89,70,,467.912,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,320.86,38.4,,256.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,320.86,38.4,,256.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,292.45,35,,233.96,percent of total billed charges,35% of total billed charges for outpatient setting,651.74,78,,521.392,percent of total billed charges,78% of total billed charges for outpatient setting,584.89,70,,467.912,percent of total billed charges,70% of total billed charges for outpatient setting,584.89,70,,467.912,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,626.67,75,,501.336,percent of total billed charges,75% of total billed charges for outpatient setting,693.51,83,,554.808,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,327.28,39.17,,261.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,693.51,
US LOWER EXT ART UNIL LEFT,1410500,CDM,921,RC,93926,HCPCS,outpatient,,,363,181.5,,254.1,70,,203.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,139.39,38.4,,111.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.39,38.4,,111.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.05,35,,101.64,percent of total billed charges,35% of total billed charges for outpatient setting,283.14,78,,226.512,percent of total billed charges,78% of total billed charges for outpatient setting,254.1,70,,203.28,percent of total billed charges,70% of total billed charges for outpatient setting,254.1,70,,203.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,272.25,75,,217.8,percent of total billed charges,75% of total billed charges for outpatient setting,301.29,83,,241.032,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.18,39.17,,113.744,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,301.29,
US UPPER EXT BIL,1410501,CDM,921,RC,93930,HCPCS,outpatient,,,498,249,,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,331.65,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,35,,139.44,percent of total billed charges,35% of total billed charges for outpatient setting,388.44,78,,310.752,percent of total billed charges,78% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,373.5,75,,298.8,percent of total billed charges,75% of total billed charges for outpatient setting,413.34,83,,330.672,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.05,39.17,,156.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,413.34,
US UPPER EXT ART UNIL LEFT,1410502,CDM,921,RC,93931,HCPCS,outpatient,,,308,154,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,118.27,38.4,,94.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.27,38.4,,94.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.8,35,,86.24,percent of total billed charges,35% of total billed charges for outpatient setting,240.24,78,,192.192,percent of total billed charges,78% of total billed charges for outpatient setting,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,231,75,,184.8,percent of total billed charges,75% of total billed charges for outpatient setting,255.64,83,,204.512,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.64,39.17,,96.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,255.64,
US CAROTID LIMITED,1410503,CDM,921,RC,93882,HCPCS,outpatient,,,394,197,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,205.96,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.9,35,,110.32,percent of total billed charges,35% of total billed charges for outpatient setting,307.32,78,,245.856,percent of total billed charges,78% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,327.02,83,,261.616,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.33,39.17,,123.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,327.02,
US VENOUS DOPPLER BIL UPPER,1410504,CDM,921,RC,93970,HCPCS,outpatient,,,471,235.5,,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.85,35,,131.88,percent of total billed charges,35% of total billed charges for outpatient setting,367.38,78,,293.904,percent of total billed charges,78% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.93,83,,312.744,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.48,39.17,,147.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.85,390.93,
US VENOUS DOPPLER UNIL LT UPPE,1410505,CDM,921,RC,93971,HCPCS,outpatient,,,288,144,,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,35,,80.64,percent of total billed charges,35% of total billed charges for outpatient setting,224.64,78,,179.712,percent of total billed charges,78% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,83,,191.232,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.8,39.17,,90.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,239.04,
US VENOUS/ARTERIAL DOPPLER,1410506,CDM,921,RC,93978,HCPCS,outpatient,,,457,228.5,,319.9,70,,255.92,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.49,38.4,,140.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.49,38.4,,140.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,298.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.95,35,,127.96,percent of total billed charges,35% of total billed charges for outpatient setting,356.46,78,,285.168,percent of total billed charges,78% of total billed charges for outpatient setting,319.9,70,,255.92,percent of total billed charges,70% of total billed charges for outpatient setting,319.9,70,,255.92,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.75,75,,274.2,percent of total billed charges,75% of total billed charges for outpatient setting,379.31,83,,303.448,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,179,39.17,,143.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.95,379.31,
NM ADRENAL SCAN,1410510,CDM,341,RC,78075,HCPCS,outpatient,,,2383,1191.5,,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,915.07,38.4,,732.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.07,38.4,,732.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,838.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.05,35,,667.24,percent of total billed charges,35% of total billed charges for outpatient setting,1858.74,78,,1486.992,percent of total billed charges,78% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1787.25,75,,1429.8,percent of total billed charges,75% of total billed charges for outpatient setting,1977.89,83,,1582.312,percent of total billed charges,83% of total billed charges for outpatient setting,3812.8,100,,,case rate,100% UHC case rate for outpatient setting,3812.8,100,,,case rate,100% UHC case rate for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,933.37,39.17,,746.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.05,3812.8,
NM BONE LIMITED,1410511,CDM,341,RC,78300,HCPCS,outpatient,,,667,333.5,,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,403.69,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,35,,186.76,percent of total billed charges,35% of total billed charges for outpatient setting,520.26,78,,416.208,percent of total billed charges,78% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,500.25,75,,400.2,percent of total billed charges,75% of total billed charges for outpatient setting,553.61,83,,442.888,percent of total billed charges,83% of total billed charges for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261.25,39.17,,209,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,1067.2,
NM BONE WHOLE,1410512,CDM,341,RC,78306,HCPCS,outpatient,,,1401,700.5,,980.7,70,,784.56,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,537.98,38.4,,430.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,537.98,38.4,,430.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,490.35,35,,392.28,percent of total billed charges,35% of total billed charges for outpatient setting,1092.78,78,,874.224,percent of total billed charges,78% of total billed charges for outpatient setting,980.7,70,,784.56,percent of total billed charges,70% of total billed charges for outpatient setting,980.7,70,,784.56,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1050.75,75,,840.6,percent of total billed charges,75% of total billed charges for outpatient setting,1162.83,83,,930.264,percent of total billed charges,83% of total billed charges for outpatient setting,2241.6,100,,,case rate,100% UHC case rate for outpatient setting,2241.6,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,548.74,39.17,,438.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,2241.6,
NM BONE 3 PHASE,1410514,CDM,341,RC,78315,HCPCS,outpatient,,,1820,910,,1274,70,,1019.2,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,698.88,38.4,,559.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,698.88,38.4,,559.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,599.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,637,35,,509.6,percent of total billed charges,35% of total billed charges for outpatient setting,1419.6,78,,1135.68,percent of total billed charges,78% of total billed charges for outpatient setting,1274,70,,1019.2,percent of total billed charges,70% of total billed charges for outpatient setting,1274,70,,1019.2,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1365,75,,1092,percent of total billed charges,75% of total billed charges for outpatient setting,1510.6,83,,1208.48,percent of total billed charges,83% of total billed charges for outpatient setting,2912,100,,,case rate,100% UHC case rate for outpatient setting,2912,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,712.86,39.17,,570.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,2912,
NM BONE SPECT,1410515,CDM,341,RC,78320,HCPCS,outpatient,,,667,333.5,,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,361.29,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,233.45,35,,186.76,percent of total billed charges,35% of total billed charges for outpatient setting,520.26,78,,416.208,percent of total billed charges,78% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,500.25,75,,400.2,percent of total billed charges,75% of total billed charges for outpatient setting,553.61,83,,442.888,percent of total billed charges,83% of total billed charges for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261.25,39.17,,209,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,233.45,1067.2,
NM BONE MULT AREAS,1410516,CDM,341,RC,78305,HCPCS,outpatient,,,667,333.5,,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,486.16,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,35,,186.76,percent of total billed charges,35% of total billed charges for outpatient setting,520.26,78,,416.208,percent of total billed charges,78% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,500.25,75,,400.2,percent of total billed charges,75% of total billed charges for outpatient setting,553.61,83,,442.888,percent of total billed charges,83% of total billed charges for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261.25,39.17,,209,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,1067.2,
NM GALLIUM TUMOR SPECT,1410521,CDM,341,RC,78803,HCPCS,outpatient,,,1353,676.5,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,588.53,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.55,35,,378.84,percent of total billed charges,35% of total billed charges for outpatient setting,1055.34,78,,844.272,percent of total billed charges,78% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges for outpatient setting,1122.99,83,,898.392,percent of total billed charges,83% of total billed charges for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,529.94,39.17,,423.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.55,2164.8,
NM GALLIUM WHOLE BODY,1410522,CDM,341,RC,78802,HCPCS,outpatient,,,1353,676.5,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,570.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.55,35,,378.84,percent of total billed charges,35% of total billed charges for outpatient setting,1055.34,78,,844.272,percent of total billed charges,78% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges for outpatient setting,1122.99,83,,898.392,percent of total billed charges,83% of total billed charges for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,529.94,39.17,,423.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.55,2164.8,
NM GALLIUM ABCESS,1410523,CDM,341,RC,78806,HCPCS,outpatient,,,1353,676.5,,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,519.55,38.4,,415.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,590.59,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,473.55,35,,378.84,percent of total billed charges,35% of total billed charges for outpatient setting,1055.34,78,,844.272,percent of total billed charges,78% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,947.1,70,,757.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1014.75,75,,811.8,percent of total billed charges,75% of total billed charges for outpatient setting,1122.99,83,,898.392,percent of total billed charges,83% of total billed charges for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,2164.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,529.94,39.17,,423.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,473.55,2164.8,
NM GASTRIC EMPTYING SCA,1410524,CDM,341,RC,78264,HCPCS,outpatient,,,1961,980.5,,1372.7,70,,1098.16,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,753.02,38.4,,602.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,753.02,38.4,,602.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,600.87,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,686.35,35,,549.08,percent of total billed charges,35% of total billed charges for outpatient setting,1529.58,78,,1223.664,percent of total billed charges,78% of total billed charges for outpatient setting,1372.7,70,,1098.16,percent of total billed charges,70% of total billed charges for outpatient setting,1372.7,70,,1098.16,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1470.75,75,,1176.6,percent of total billed charges,75% of total billed charges for outpatient setting,1627.63,83,,1302.104,percent of total billed charges,83% of total billed charges for outpatient setting,3137.6,100,,,case rate,100% UHC case rate for outpatient setting,3137.6,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,768.08,39.17,,614.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,3137.6,
NM G I BLEEDER,1410526,CDM,341,RC,78278,HCPCS,outpatient,,,857,428.5,,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,329.09,38.4,,263.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.09,38.4,,263.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,607.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,299.95,35,,239.96,percent of total billed charges,35% of total billed charges for outpatient setting,668.46,78,,534.768,percent of total billed charges,78% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,599.9,70,,479.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,642.75,75,,514.2,percent of total billed charges,75% of total billed charges for outpatient setting,711.31,83,,569.048,percent of total billed charges,83% of total billed charges for outpatient setting,1371.2,100,,,case rate,100% UHC case rate for outpatient setting,1371.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,335.67,39.17,,268.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,299.95,1371.2,
NM HEART MUGA,1410527,CDM,341,RC,78481,HCPCS,outpatient,,,789,394.5,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,258.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.15,35,,220.92,percent of total billed charges,35% of total billed charges for outpatient setting,615.42,78,,492.336,percent of total billed charges,78% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.75,75,,473.4,percent of total billed charges,75% of total billed charges for outpatient setting,654.87,83,,523.896,percent of total billed charges,83% of total billed charges for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.04,39.17,,247.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.24,1262.4,
NM HEART MYO/CARD SPECT,1410528,CDM,341,RC,78469,HCPCS,outpatient,,,789,394.5,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,372.95,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.15,35,,220.92,percent of total billed charges,35% of total billed charges for outpatient setting,615.42,78,,492.336,percent of total billed charges,78% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.75,75,,473.4,percent of total billed charges,75% of total billed charges for outpatient setting,654.87,83,,523.896,percent of total billed charges,83% of total billed charges for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.04,39.17,,247.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.15,1262.4,
NM HEART MYO/INFART,1410529,CDM,341,RC,78466,HCPCS,outpatient,,,789,394.5,,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,302.98,38.4,,242.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,328.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.15,35,,220.92,percent of total billed charges,35% of total billed charges for outpatient setting,615.42,78,,492.336,percent of total billed charges,78% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,552.3,70,,441.84,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.75,75,,473.4,percent of total billed charges,75% of total billed charges for outpatient setting,654.87,83,,523.896,percent of total billed charges,83% of total billed charges for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,1262.4,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.04,39.17,,247.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.15,1262.4,
NM HEART STRESS MUGA,1410532,CDM,341,RC,78483,HCPCS,outpatient,,,2374,1187,,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,911.62,38.4,,729.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,911.62,38.4,,729.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,346.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,830.9,35,,664.72,percent of total billed charges,35% of total billed charges for outpatient setting,1851.72,78,,1481.376,percent of total billed charges,78% of total billed charges for outpatient setting,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1780.5,75,,1424.4,percent of total billed charges,75% of total billed charges for outpatient setting,1970.42,83,,1576.336,percent of total billed charges,83% of total billed charges for outpatient setting,3798.4,100,,,case rate,100% UHC case rate for outpatient setting,3798.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,929.85,39.17,,743.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,346.2,3798.4,
NM KIDNEY VASCULAR W/O,1410538,CDM,341,RC,78707,HCPCS,outpatient,,,859,429.5,,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,377.06,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,35,,240.52,percent of total billed charges,35% of total billed charges for outpatient setting,670.02,78,,536.016,percent of total billed charges,78% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,712.97,83,,570.376,percent of total billed charges,83% of total billed charges for outpatient setting,1374.4,100,,,case rate,100% UHC case rate for outpatient setting,1374.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.46,39.17,,269.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,1374.4,
NM LIVER IMAGING,1410543,CDM,341,RC,78205,HCPCS,outpatient,,,767,383.5,,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,359.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.45,35,,214.76,percent of total billed charges,35% of total billed charges for outpatient setting,598.26,78,,478.608,percent of total billed charges,78% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,575.25,75,,460.2,percent of total billed charges,75% of total billed charges for outpatient setting,636.61,83,,509.288,percent of total billed charges,83% of total billed charges for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,300.42,39.17,,240.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,268.45,1227.2,
NM LIVER/SPLEEN,1410544,CDM,341,RC,78215,HCPCS,outpatient,,,767,383.5,,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,344.14,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.45,35,,214.76,percent of total billed charges,35% of total billed charges for outpatient setting,598.26,78,,478.608,percent of total billed charges,78% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,575.25,75,,460.2,percent of total billed charges,75% of total billed charges for outpatient setting,636.61,83,,509.288,percent of total billed charges,83% of total billed charges for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.42,39.17,,240.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.45,1227.2,
NM LIVER/SPLEN FLOW,1410545,CDM,341,RC,78216,HCPCS,outpatient,,,767,383.5,,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,200.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.45,35,,214.76,percent of total billed charges,35% of total billed charges for outpatient setting,598.26,78,,478.608,percent of total billed charges,78% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,575.25,75,,460.2,percent of total billed charges,75% of total billed charges for outpatient setting,636.61,83,,509.288,percent of total billed charges,83% of total billed charges for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,1227.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.42,39.17,,240.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,200.74,1227.2,
NM LUNG PERFUSION,1410546,CDM,341,RC,78580,HCPCS,outpatient,,,498,249,,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.23,38.4,,152.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,409.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,35,,139.44,percent of total billed charges,35% of total billed charges for outpatient setting,388.44,78,,310.752,percent of total billed charges,78% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,348.6,70,,278.88,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,373.5,75,,298.8,percent of total billed charges,75% of total billed charges for outpatient setting,413.34,83,,330.672,percent of total billed charges,83% of total billed charges for outpatient setting,796.8,100,,,case rate,100% UHC case rate for outpatient setting,796.8,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.05,39.17,,156.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.3,796.8,
NM MECKEL'S DIVERTICULU,1410550,CDM,341,RC,78290,HCPCS,outpatient,,,667,333.5,,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.13,38.4,,204.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,601.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,35,,186.76,percent of total billed charges,35% of total billed charges for outpatient setting,520.26,78,,416.208,percent of total billed charges,78% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,466.9,70,,373.52,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,500.25,75,,400.2,percent of total billed charges,75% of total billed charges for outpatient setting,553.61,83,,442.888,percent of total billed charges,83% of total billed charges for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,1067.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261.25,39.17,,209,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,233.45,1067.2,
US OB OVER 14 WKS MULTIPLE,1410552,CDM,402,RC,76810,HCPCS,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,84.4,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,534.4,100,,,case rate,100% UHC case rate for outpatient setting,534.4,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84.4,534.4,
NM SCROTAL SCAN,1410555,CDM,341,RC,78761,HCPCS,outpatient,,,859,429.5,,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.42,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,35,,240.52,percent of total billed charges,35% of total billed charges for outpatient setting,670.02,78,,536.016,percent of total billed charges,78% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,712.97,83,,570.376,percent of total billed charges,83% of total billed charges for outpatient setting,1374.4,100,,,case rate,100% UHC case rate for outpatient setting,1374.4,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.46,39.17,,269.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,1374.4,
US EXTREMITY LEFT UPPER,1410557,CDM,402,RC,76882,HCPCS,outpatient,,,545,272.5,,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,35,,152.6,percent of total billed charges,35% of total billed charges for outpatient setting,425.1,78,,340.08,percent of total billed charges,78% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.75,75,,327,percent of total billed charges,75% of total billed charges for outpatient setting,452.35,83,,361.88,percent of total billed charges,83% of total billed charges for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.47,39.17,,170.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.62,872,
US GUIDE CYST,1410559,CDM,402,RC,76942,HCPCS,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.15,35,,41.72,percent of total billed charges,35% of total billed charges for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,238.4,100,,,case rate,100% UHC case rate for outpatient setting,238.4,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.36,39.17,,46.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.15,238.4,
NM PARA THYROID,1410561,CDM,341,RC,78070,HCPCS,outpatient,,,828,414,,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,317.95,38.4,,254.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.95,38.4,,254.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.8,35,,231.84,percent of total billed charges,35% of total billed charges for outpatient setting,645.84,78,,516.672,percent of total billed charges,78% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,621,75,,496.8,percent of total billed charges,75% of total billed charges for outpatient setting,687.24,83,,549.792,percent of total billed charges,83% of total billed charges for outpatient setting,1324.8,100,,,case rate,100% UHC case rate for outpatient setting,1324.8,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.31,39.17,,259.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.8,1324.8,
NM RADIONUCLIDE,1410563,CDM,255,RC,A4641,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
NM MYOCARDIAL/HEART WALL MOTION,1410574,CDM,341,RC,78452,HCPCS,outpatient,,,4208.18,2104.09,,2945.73,70,,2356.584,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1615.94,38.4,,1292.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1615.94,38.4,,1292.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,800.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1472.86,35,,1178.288,percent of total billed charges,35% of total billed charges for outpatient setting,3282.38,78,,2625.904,percent of total billed charges,78% of total billed charges for outpatient setting,2945.73,70,,2356.584,percent of total billed charges,70% of total billed charges for outpatient setting,2945.73,70,,2356.584,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3156.14,75,,2524.912,percent of total billed charges,75% of total billed charges for outpatient setting,3492.79,83,,2794.232,percent of total billed charges,83% of total billed charges for outpatient setting,6733.09,100,,,case rate,100% UHC case rate for outpatient setting,6733.09,100,,,case rate,100% UHC case rate for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1648.26,39.17,,1318.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,800.11,6733.09,
US SOFT TISSUE/THYROID,1410578,CDM,402,RC,76536,HCPCS,outpatient,,,392,196,,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.2,35,,109.76,percent of total billed charges,35% of total billed charges for outpatient setting,305.76,78,,244.608,percent of total billed charges,78% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,325.36,83,,260.288,percent of total billed charges,83% of total billed charges for outpatient setting,627.2,100,,,case rate,100% UHC case rate for outpatient setting,627.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.54,39.17,,122.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,627.2,
US HEAD AND NECK,1410591,CDM,402,RC,76536,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1304,
US SEGMENTAL BP ARTERY BILATER,1410595,CDM,921,RC,93922,HCPCS,outpatient,,,255.73,127.87,,179.01,70,,143.208,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.2,38.4,,78.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.2,38.4,,78.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,147.64,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.51,35,,71.608,percent of total billed charges,35% of total billed charges for outpatient setting,199.47,78,,159.576,percent of total billed charges,78% of total billed charges for outpatient setting,179.01,70,,143.208,percent of total billed charges,70% of total billed charges for outpatient setting,179.01,70,,143.208,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.8,75,,153.44,percent of total billed charges,75% of total billed charges for outpatient setting,212.26,83,,169.808,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.16,39.17,,80.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.51,212.26,
NM SENTINEL LYMPH NODE (BREAST),1410597,CDM,341,RC,78195,HCPCS,outpatient,,,877,438.5,,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,336.77,38.4,,269.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336.77,38.4,,269.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,602.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.95,35,,245.56,percent of total billed charges,35% of total billed charges for outpatient setting,684.06,78,,547.248,percent of total billed charges,78% of total billed charges for outpatient setting,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,613.9,70,,491.12,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,657.75,75,,526.2,percent of total billed charges,75% of total billed charges for outpatient setting,727.91,83,,582.328,percent of total billed charges,83% of total billed charges for outpatient setting,1403.2,100,,,case rate,100% UHC case rate for outpatient setting,1403.2,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,343.51,39.17,,274.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.95,1403.2,
US OB LESS 14 WKS MULTIPLE,1410598,CDM,402,RC,76802,HCPCS,outpatient,,,309,154.5,,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,118.66,38.4,,94.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.66,38.4,,94.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.15,35,,86.52,percent of total billed charges,35% of total billed charges for outpatient setting,241.02,78,,192.816,percent of total billed charges,78% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,216.3,70,,173.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231.75,75,,185.4,percent of total billed charges,75% of total billed charges for outpatient setting,256.47,83,,205.176,percent of total billed charges,83% of total billed charges for outpatient setting,494.4,100,,,case rate,100% UHC case rate for outpatient setting,494.4,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.03,39.17,,96.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.91,494.4,
NM PERSANTINE PER 10 MG,1410602,CDM,636,RC,J1245,HCPCS,both,,,374,187,,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.72,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.72,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,280.5,75,,224.4,percent of total billed charges,75% of total billed charges for outpatient setting,280.5,75,,224.4,percent of total billed charges,75% of total billed charges for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,280.5,75,,224.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.91,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,291.72,78,,233.376,percent of total billed charges,78% of total billed charges for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.8,70,,209.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,280.5,75,,224.4,percent of total billed charges,75% of total billed charges for outpatient setting,310.42,83,,248.336,percent of total billed charges,83% of total billed charges for outpatient setting,187,50,,149.6,percent of total billed charges,50% of total billed charges for outpatient setting,187,50,,149.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.72,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.72,310.42,
CT LOWER EXT W&WO CO RIGHT,1410611,CDM,352,RC,73702,HCPCS,outpatient,,,2020,1010,,1414,70,,1131.2,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,775.68,38.4,,620.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,775.68,38.4,,620.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,707,35,,565.6,percent of total billed charges,35% of total billed charges for outpatient setting,1575.6,78,,1260.48,percent of total billed charges,78% of total billed charges for outpatient setting,1414,70,,1131.2,percent of total billed charges,70% of total billed charges for outpatient setting,1414,70,,1131.2,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1515,75,,1212,percent of total billed charges,75% of total billed charges for outpatient setting,1676.6,83,,1341.28,percent of total billed charges,83% of total billed charges for outpatient setting,3232,100,,,case rate,100% UHC case rate for outpatient setting,3232,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,791.19,39.17,,632.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,3232,
CT LOWER EXT W/CONT RIGHT,1410612,CDM,352,RC,73701,HCPCS,outpatient,,,898,449,,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,314.3,35,,251.44,percent of total billed charges,35% of total billed charges for outpatient setting,700.44,78,,560.352,percent of total billed charges,78% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,673.5,75,,538.8,percent of total billed charges,75% of total billed charges for outpatient setting,745.34,83,,596.272,percent of total billed charges,83% of total billed charges for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.73,39.17,,281.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1436.8,
CT LOWER EXT W/O CON RIGHT,1410613,CDM,352,RC,73700,HCPCS,outpatient,,,432,216,,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.2,35,,120.96,percent of total billed charges,35% of total billed charges for outpatient setting,336.96,78,,269.568,percent of total billed charges,78% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,358.56,83,,286.848,percent of total billed charges,83% of total billed charges for outpatient setting,691.2,100,,,case rate,100% UHC case rate for outpatient setting,691.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.21,39.17,,135.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,691.2,
CT UPPER EXT WO/CON RIGHT,1410614,CDM,352,RC,73200,HCPCS,outpatient,,,456,228,,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.6,35,,127.68,percent of total billed charges,35% of total billed charges for outpatient setting,355.68,78,,284.544,percent of total billed charges,78% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,378.48,83,,302.784,percent of total billed charges,83% of total billed charges for outpatient setting,729.6,100,,,case rate,100% UHC case rate for outpatient setting,729.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.6,39.17,,142.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,729.6,
CT UPPER EXT W&WO CONT RIGHT,1410615,CDM,352,RC,73202,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
CT UPPER EXT W/CON RIGHT,1410616,CDM,352,RC,73201,HCPCS,outpatient,,,1794,897,,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,688.9,38.4,,551.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,627.9,35,,502.32,percent of total billed charges,35% of total billed charges for outpatient setting,1399.32,78,,1119.456,percent of total billed charges,78% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,1255.8,70,,1004.64,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1345.5,75,,1076.4,percent of total billed charges,75% of total billed charges for outpatient setting,1489.02,83,,1191.216,percent of total billed charges,83% of total billed charges for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,2870.4,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,702.68,39.17,,562.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,2870.4,
US EXTREMITY RIGHT LOWER,1410644,CDM,402,RC,76882,HCPCS,outpatient,,,545,272.5,,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,35,,152.6,percent of total billed charges,35% of total billed charges for outpatient setting,425.1,78,,340.08,percent of total billed charges,78% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.75,75,,327,percent of total billed charges,75% of total billed charges for outpatient setting,452.35,83,,361.88,percent of total billed charges,83% of total billed charges for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.47,39.17,,170.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.62,872,
US LOWER EXT ART UNIL RIGHT,1410654,CDM,921,RC,93926,HCPCS,outpatient,,,582,291,,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.49,38.4,,178.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,252.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.7,35,,162.96,percent of total billed charges,35% of total billed charges for outpatient setting,453.96,78,,363.168,percent of total billed charges,78% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,407.4,70,,325.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,436.5,75,,349.2,percent of total billed charges,75% of total billed charges for outpatient setting,483.06,83,,386.448,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.96,39.17,,182.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,483.06,
US UPPER EXT ART UNIL RIGHT,1410655,CDM,921,RC,93931,HCPCS,outpatient,,,308,154,,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,118.27,38.4,,94.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.27,38.4,,94.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.8,35,,86.24,percent of total billed charges,35% of total billed charges for outpatient setting,240.24,78,,192.192,percent of total billed charges,78% of total billed charges for outpatient setting,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,215.6,70,,172.48,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,231,75,,184.8,percent of total billed charges,75% of total billed charges for outpatient setting,255.64,83,,204.512,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.64,39.17,,96.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,255.64,
US EXTREMITY RIGHT UPPER,1410656,CDM,402,RC,76882,HCPCS,outpatient,,,545,272.5,,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,35,,152.6,percent of total billed charges,35% of total billed charges for outpatient setting,425.1,78,,340.08,percent of total billed charges,78% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.75,75,,327,percent of total billed charges,75% of total billed charges for outpatient setting,452.35,83,,361.88,percent of total billed charges,83% of total billed charges for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.47,39.17,,170.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.62,872,
US EXTREMITY LEFT LOWER,1410657,CDM,402,RC,76882,HCPCS,outpatient,,,545,272.5,,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,209.28,38.4,,167.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,35,,152.6,percent of total billed charges,35% of total billed charges for outpatient setting,425.1,78,,340.08,percent of total billed charges,78% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,381.5,70,,305.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.75,75,,327,percent of total billed charges,75% of total billed charges for outpatient setting,452.35,83,,361.88,percent of total billed charges,83% of total billed charges for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,872,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.47,39.17,,170.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.62,872,
US VENOUS DOPPLER UNIL RT UPPE,1410658,CDM,921,RC,93971,HCPCS,outpatient,,,288,144,,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,35,,80.64,percent of total billed charges,35% of total billed charges for outpatient setting,224.64,78,,179.712,percent of total billed charges,78% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,83,,191.232,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.8,39.17,,90.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,239.04,
US VENOUS DOPPLER UNIL LT LOW,1410659,CDM,921,RC,93971,HCPCS,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,947.03,
US VENOUS DOPPLER UNIL RT LOWE,1410660,CDM,921,RC,93971,HCPCS,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,192.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,947.03,
US VENOUS DOPPLER BIL LOWER,1410661,CDM,921,RC,93970,HCPCS,outpatient,,,397.52,198.76,,278.26,70,,222.608,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,152.65,38.4,,122.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.65,38.4,,122.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,317.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,139.13,35,,111.304,percent of total billed charges,35% of total billed charges for outpatient setting,310.07,78,,248.056,percent of total billed charges,78% of total billed charges for outpatient setting,278.26,70,,222.608,percent of total billed charges,70% of total billed charges for outpatient setting,278.26,70,,222.608,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,298.14,75,,238.512,percent of total billed charges,75% of total billed charges for outpatient setting,329.94,83,,263.952,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,155.7,39.17,,124.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,139.13,329.94,
US COLOR DOPPLER,1410662,CDM,921,RC,93975,HCPCS,outpatient,,,674,337,,471.8,70,,377.44,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,258.82,38.4,,207.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,258.82,38.4,,207.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,235.9,35,,188.72,percent of total billed charges,35% of total billed charges for outpatient setting,525.72,78,,420.576,percent of total billed charges,78% of total billed charges for outpatient setting,471.8,70,,377.44,percent of total billed charges,70% of total billed charges for outpatient setting,471.8,70,,377.44,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.5,75,,404.4,percent of total billed charges,75% of total billed charges for outpatient setting,559.42,83,,447.536,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,264,39.17,,211.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,559.42,
US GUIDE VASCULAR,1410663,CDM,402,RC,76937,HCPCS,outpatient,,,361,180.5,,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.62,38.4,,110.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.62,38.4,,110.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,32.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.35,35,,101.08,percent of total billed charges,35% of total billed charges for outpatient setting,281.58,78,,225.264,percent of total billed charges,78% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.75,75,,216.6,percent of total billed charges,75% of total billed charges for outpatient setting,299.63,83,,239.704,percent of total billed charges,83% of total billed charges for outpatient setting,577.6,100,,,case rate,100% UHC case rate for outpatient setting,577.6,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141.39,39.17,,113.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.92,577.6,
US RENAL ARTERY,1410664,CDM,921,RC,93975,HCPCS,outpatient,,,826,413,,578.2,70,,462.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,317.18,38.4,,253.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317.18,38.4,,253.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,441.57,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.1,35,,231.28,percent of total billed charges,35% of total billed charges for outpatient setting,644.28,78,,515.424,percent of total billed charges,78% of total billed charges for outpatient setting,578.2,70,,462.56,percent of total billed charges,70% of total billed charges for outpatient setting,578.2,70,,462.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,619.5,75,,495.6,percent of total billed charges,75% of total billed charges for outpatient setting,685.58,83,,548.464,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,323.52,39.17,,258.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,685.58,
US LOWER EX ARTERIAL BILATERAL,1417728,CDM,921,RC,93925,HCPCS,outpatient,,,520.75,260.38,,364.53,70,,291.624,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,199.97,38.4,,159.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,199.97,38.4,,159.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,434.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.26,35,,145.808,percent of total billed charges,35% of total billed charges for outpatient setting,406.19,78,,324.952,percent of total billed charges,78% of total billed charges for outpatient setting,364.53,70,,291.624,percent of total billed charges,70% of total billed charges for outpatient setting,364.53,70,,291.624,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,390.56,75,,312.448,percent of total billed charges,75% of total billed charges for outpatient setting,432.22,83,,345.776,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,203.97,39.17,,163.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.26,434.03,
NM GASTRIC EMPTYING W/SMBOWEL/COL,1417740,CDM,341,RC,78266,HCPCS,outpatient,,,1159,579.5,,811.3,70,,649.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,445.06,38.4,,356.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445.06,38.4,,356.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,852.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,405.65,35,,324.52,percent of total billed charges,35% of total billed charges for outpatient setting,904.02,78,,723.216,percent of total billed charges,78% of total billed charges for outpatient setting,811.3,70,,649.04,percent of total billed charges,70% of total billed charges for outpatient setting,811.3,70,,649.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,869.25,75,,695.4,percent of total billed charges,75% of total billed charges for outpatient setting,961.97,83,,769.576,percent of total billed charges,83% of total billed charges for outpatient setting,1854.4,100,,,case rate,100% UHC case rate for outpatient setting,1854.4,100,,,case rate,100% UHC case rate for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,453.96,39.17,,363.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,405.65,1854.4,
NM GASTRIC EMPTYING W/SM BOWEL TR,1417741,CDM,341,RC,78265,HCPCS,outpatient,,,979,489.5,,685.3,70,,548.24,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,375.94,38.4,,300.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,375.94,38.4,,300.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,708.74,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.65,35,,274.12,percent of total billed charges,35% of total billed charges for outpatient setting,763.62,78,,610.896,percent of total billed charges,78% of total billed charges for outpatient setting,685.3,70,,548.24,percent of total billed charges,70% of total billed charges for outpatient setting,685.3,70,,548.24,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,734.25,75,,587.4,percent of total billed charges,75% of total billed charges for outpatient setting,812.57,83,,650.056,percent of total billed charges,83% of total billed charges for outpatient setting,1566.4,100,,,case rate,100% UHC case rate for outpatient setting,1566.4,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,383.46,39.17,,306.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.65,1566.4,
CT CHEST/PE PROTOCOL,1419991,CDM,320,RC,71275,HCPCS,outpatient,,,2662.82,1331.41,,1863.97,70,,1491.176,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1022.52,38.4,,818.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1022.52,38.4,,818.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,931.99,35,,745.592,percent of total billed charges,35% of total billed charges for outpatient setting,2077,78,,1661.6,percent of total billed charges,78% of total billed charges for outpatient setting,1863.97,70,,1491.176,percent of total billed charges,70% of total billed charges for outpatient setting,1863.97,70,,1491.176,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1997.12,75,,1597.696,percent of total billed charges,75% of total billed charges for outpatient setting,2210.14,83,,1768.112,percent of total billed charges,83% of total billed charges for outpatient setting,1331.41,50,,1065.128,percent of total billed charges,50% of total billed charges for outpatient setting,1331.41,50,,1065.128,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1042.97,39.17,,834.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2210.14,
CT CHEST PE/ABD/PEL W/WO,1419992,CDM,320,RC,71275,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
CT CHEST PE/ABD W/WO,1419993,CDM,320,RC,71275,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
CT CHEST PE/ABD/PEL W/,1419994,CDM,320,RC,71275,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
CT CHEST PE/ABD W/,1419995,CDM,320,RC,71275,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
CT CHEST/ABD/PEL W/WO,1419996,CDM,352,RC,71270,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
US PELVIC LIMITED - BLADDER,1419997,CDM,402,RC,76857,HCPCS,outpatient,,,389,194.5,,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,149.38,38.4,,119.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.38,38.4,,119.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.15,35,,108.92,percent of total billed charges,35% of total billed charges for outpatient setting,303.42,78,,242.736,percent of total billed charges,78% of total billed charges for outpatient setting,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,291.75,75,,233.4,percent of total billed charges,75% of total billed charges for outpatient setting,322.87,83,,258.296,percent of total billed charges,83% of total billed charges for outpatient setting,622.4,100,,,case rate,100% UHC case rate for outpatient setting,622.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.37,39.17,,121.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,622.4,
CT BRAIN W/O CONTRAST,1430001,CDM,351,RC,70450,HCPCS,outpatient,,,329.16,164.58,,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.4,38.4,,101.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.4,38.4,,101.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.21,35,,92.168,percent of total billed charges,35% of total billed charges for outpatient setting,256.74,78,,205.392,percent of total billed charges,78% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.87,75,,197.496,percent of total billed charges,75% of total billed charges for outpatient setting,273.2,83,,218.56,percent of total billed charges,83% of total billed charges for outpatient setting,526.66,100,,,case rate,100% UHC case rate for outpatient setting,526.66,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.93,39.17,,103.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,526.66,
CT BRAIN W/CONTRAST,1430013,CDM,351,RC,70460,HCPCS,outpatient,,,898,449,,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,344.83,38.4,,275.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,314.3,35,,251.44,percent of total billed charges,35% of total billed charges for outpatient setting,700.44,78,,560.352,percent of total billed charges,78% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,628.6,70,,502.88,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,673.5,75,,538.8,percent of total billed charges,75% of total billed charges for outpatient setting,745.34,83,,596.272,percent of total billed charges,83% of total billed charges for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,1436.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.73,39.17,,281.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,1436.8,
CT CHEST W/O CONTRA,1430017,CDM,352,RC,71250,HCPCS,outpatient,,,366.3,183.15,,256.41,70,,205.128,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,140.66,38.4,,112.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.66,38.4,,112.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.21,35,,102.568,percent of total billed charges,35% of total billed charges for outpatient setting,285.71,78,,228.568,percent of total billed charges,78% of total billed charges for outpatient setting,256.41,70,,205.128,percent of total billed charges,70% of total billed charges for outpatient setting,256.41,70,,205.128,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,274.73,75,,219.784,percent of total billed charges,75% of total billed charges for outpatient setting,304.03,83,,243.224,percent of total billed charges,83% of total billed charges for outpatient setting,586.08,100,,,case rate,100% UHC case rate for outpatient setting,586.08,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.47,39.17,,114.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,586.08,
US ABD (SPECIFY OR,1430018,CDM,402,RC,76705,HCPCS,outpatient,,,1141,570.5,,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,438.14,38.4,,350.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,399.35,35,,319.48,percent of total billed charges,35% of total billed charges for outpatient setting,889.98,78,,711.984,percent of total billed charges,78% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,798.7,70,,638.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,855.75,75,,684.6,percent of total billed charges,75% of total billed charges for outpatient setting,947.03,83,,757.624,percent of total billed charges,83% of total billed charges for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,1825.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,446.9,39.17,,357.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1825.6,
US ABD FOLLOW-UP,1430022,CDM,402,RC,76705,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
US AORTA,1430032,CDM,402,RC,76775,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,312,100,,,case rate,100% UHC case rate for outpatient setting,312,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,312,
US PANCREAS,1430036,CDM,402,RC,76775,HCPCS,outpatient,,,144,72,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,55.3,38.4,,44.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.3,38.4,,44.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,35,,40.32,percent of total billed charges,35% of total billed charges for outpatient setting,112.32,78,,89.856,percent of total billed charges,78% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.52,83,,95.616,percent of total billed charges,83% of total billed charges for outpatient setting,230.4,100,,,case rate,100% UHC case rate for outpatient setting,230.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.41,39.17,,45.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,230.4,
US RENAL,1430038,CDM,402,RC,76775,HCPCS,outpatient,,,687.86,343.93,,481.5,70,,385.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,264.14,38.4,,211.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,264.14,38.4,,211.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,240.75,35,,192.6,percent of total billed charges,35% of total billed charges for outpatient setting,536.53,78,,429.224,percent of total billed charges,78% of total billed charges for outpatient setting,481.5,70,,385.2,percent of total billed charges,70% of total billed charges for outpatient setting,481.5,70,,385.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.9,75,,412.72,percent of total billed charges,75% of total billed charges for outpatient setting,570.92,83,,456.736,percent of total billed charges,83% of total billed charges for outpatient setting,1100.58,100,,,case rate,100% UHC case rate for outpatient setting,1100.58,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.42,39.17,,215.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,1100.58,
US THYROID (E),1430040,CDM,402,RC,76536,HCPCS,outpatient,,,280,140,,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,173.03,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,98,35,,78.4,percent of total billed charges,35% of total billed charges for outpatient setting,218.4,78,,174.72,percent of total billed charges,78% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210,75,,168,percent of total billed charges,75% of total billed charges for outpatient setting,232.4,83,,185.92,percent of total billed charges,83% of total billed charges for outpatient setting,448,100,,,case rate,100% UHC case rate for outpatient setting,448,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.67,39.17,,87.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,448,
CT ORBIT W/O CONTR,1430043,CDM,351,RC,70480,HCPCS,outpatient,,,559,279.5,,391.3,70,,313.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,214.66,38.4,,171.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,214.66,38.4,,171.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.65,35,,156.52,percent of total billed charges,35% of total billed charges for outpatient setting,436.02,78,,348.816,percent of total billed charges,78% of total billed charges for outpatient setting,391.3,70,,313.04,percent of total billed charges,70% of total billed charges for outpatient setting,391.3,70,,313.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,419.25,75,,335.4,percent of total billed charges,75% of total billed charges for outpatient setting,463.97,83,,371.176,percent of total billed charges,83% of total billed charges for outpatient setting,894.4,100,,,case rate,100% UHC case rate for outpatient setting,894.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,218.95,39.17,,175.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,894.4,
CT ORBIT W/CONTR,1430046,CDM,351,RC,70481,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2051.2,
CT ORBIT W-WO/CONTR,1430047,CDM,351,RC,70482,HCPCS,outpatient,,,3030,1515,,2121,70,,1696.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1163.52,38.4,,930.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1163.52,38.4,,930.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1060.5,35,,848.4,percent of total billed charges,35% of total billed charges for outpatient setting,2363.4,78,,1890.72,percent of total billed charges,78% of total billed charges for outpatient setting,2121,70,,1696.8,percent of total billed charges,70% of total billed charges for outpatient setting,2121,70,,1696.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2272.5,75,,1818,percent of total billed charges,75% of total billed charges for outpatient setting,2514.9,83,,2011.92,percent of total billed charges,83% of total billed charges for outpatient setting,4848,100,,,case rate,100% UHC case rate for outpatient setting,4848,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1186.79,39.17,,949.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,4848,
US BREAST UNILAT RT,1430061,CDM,402,RC,76641,HCPCS,outpatient,,,775.6,387.8,,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,297.83,38.4,,238.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.83,38.4,,238.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,271.46,35,,217.168,percent of total billed charges,35% of total billed charges for outpatient setting,604.97,78,,483.976,percent of total billed charges,78% of total billed charges for outpatient setting,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,581.7,75,,465.36,percent of total billed charges,75% of total billed charges for outpatient setting,643.75,83,,515,percent of total billed charges,83% of total billed charges for outpatient setting,1240.96,100,,,case rate,100% UHC case rate for outpatient setting,1240.96,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,303.79,39.17,,243.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1240.96,
US BILATERAL BREAST ULTRASOUND,1430062,CDM,402,RC,76641,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,138.73,
NM KIDNEY SINGLE W/LASIX,1430063,CDM,320,RC,78708,HCPCS,outpatient,,,859,429.5,,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,237.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,35,,240.52,percent of total billed charges,35% of total billed charges for outpatient setting,670.02,78,,536.016,percent of total billed charges,78% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,712.97,83,,570.376,percent of total billed charges,83% of total billed charges for outpatient setting,429.5,50,,343.6,percent of total billed charges,50% of total billed charges for outpatient setting,429.5,50,,343.6,percent of total billed charges,50% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.46,39.17,,269.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,237.25,712.97,
NM KIDNEY MULT,1430064,CDM,320,RC,78709,HCPCS,outpatient,,,900,450,,630,70,,504,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,345.6,38.4,,276.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345.6,38.4,,276.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.31,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,315,35,,252,percent of total billed charges,35% of total billed charges for outpatient setting,702,78,,561.6,percent of total billed charges,78% of total billed charges for outpatient setting,630,70,,504,percent of total billed charges,70% of total billed charges for outpatient setting,630,70,,504,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,675,75,,540,percent of total billed charges,75% of total billed charges for outpatient setting,747,83,,597.6,percent of total billed charges,83% of total billed charges for outpatient setting,450,50,,360,percent of total billed charges,50% of total billed charges for outpatient setting,450,50,,360,percent of total billed charges,50% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,352.51,39.17,,282.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,315,747,
US GB,1430065,CDM,402,RC,76705,HCPCS,outpatient,,,815,407.5,,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,312.96,38.4,,250.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.25,35,,228.2,percent of total billed charges,35% of total billed charges for outpatient setting,635.7,78,,508.56,percent of total billed charges,78% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,570.5,70,,456.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.25,75,,489,percent of total billed charges,75% of total billed charges for outpatient setting,676.45,83,,541.16,percent of total billed charges,83% of total billed charges for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,1304,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.22,39.17,,255.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1304,
US INFERIOR VENA CAVA,1430066,CDM,402,RC,76775,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,443.2,
US SPLEEN,1430067,CDM,402,RC,76705,HCPCS,outpatient,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,121.58,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,443.2,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,443.2,
US CAROTID DUPLEX DOPPL,1430100,CDM,921,RC,93880,HCPCS,outpatient,,,408.5,204.25,,285.95,70,,228.76,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.86,38.4,,125.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.86,38.4,,125.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,320.67,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.98,35,,114.384,percent of total billed charges,35% of total billed charges for outpatient setting,318.63,78,,254.904,percent of total billed charges,78% of total billed charges for outpatient setting,285.95,70,,228.76,percent of total billed charges,70% of total billed charges for outpatient setting,285.95,70,,228.76,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.38,75,,245.104,percent of total billed charges,75% of total billed charges for outpatient setting,339.06,83,,271.248,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160,39.17,,128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.98,339.06,
CT CHEST W/CONTRAST,1430102,CDM,352,RC,71260,HCPCS,outpatient,,,5273.8,2636.9,,3691.66,70,,2953.328,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2025.14,38.4,,1620.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2025.14,38.4,,1620.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1845.83,35,,1476.664,percent of total billed charges,35% of total billed charges for outpatient setting,4113.56,78,,3290.848,percent of total billed charges,78% of total billed charges for outpatient setting,3691.66,70,,2953.328,percent of total billed charges,70% of total billed charges for outpatient setting,3691.66,70,,2953.328,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3955.35,75,,3164.28,percent of total billed charges,75% of total billed charges for outpatient setting,4377.25,83,,3501.8,percent of total billed charges,83% of total billed charges for outpatient setting,8438.08,100,,,case rate,100% UHC case rate for outpatient setting,8438.08,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2065.64,39.17,,1652.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,8438.08,
CT CHEST W-W/O CONTR,1430103,CDM,352,RC,71270,HCPCS,outpatient,,,5938.8,2969.4,,4157.16,70,,3325.728,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2280.5,38.4,,1824.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2280.5,38.4,,1824.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2078.58,35,,1662.864,percent of total billed charges,35% of total billed charges for outpatient setting,4632.26,78,,3705.808,percent of total billed charges,78% of total billed charges for outpatient setting,4157.16,70,,3325.728,percent of total billed charges,70% of total billed charges for outpatient setting,4157.16,70,,3325.728,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4454.1,75,,3563.28,percent of total billed charges,75% of total billed charges for outpatient setting,4929.2,83,,3943.36,percent of total billed charges,83% of total billed charges for outpatient setting,9502.08,100,,,case rate,100% UHC case rate for outpatient setting,9502.08,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2326.11,39.17,,1860.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,9502.08,
CT CERVICAL SP 5-7 W/O CONTRAS,1430105,CDM,352,RC,72125,HCPCS,outpatient,,,638.4,319.2,,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,245.15,38.4,,196.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.15,38.4,,196.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,223.44,35,,178.752,percent of total billed charges,35% of total billed charges for outpatient setting,497.95,78,,398.36,percent of total billed charges,78% of total billed charges for outpatient setting,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,478.8,75,,383.04,percent of total billed charges,75% of total billed charges for outpatient setting,529.87,83,,423.896,percent of total billed charges,83% of total billed charges for outpatient setting,1021.44,100,,,case rate,100% UHC case rate for outpatient setting,1021.44,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,250.05,39.17,,200.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1021.44,
CT CERVICAL SP W/CON,1430106,CDM,352,RC,72126,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,2051.2,
CT THORACIC SPINE W/O CONTRAST,1430108,CDM,352,RC,72128,HCPCS,outpatient,,,2678.2,1339.1,,1874.74,70,,1499.792,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1028.43,38.4,,822.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1028.43,38.4,,822.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,937.37,35,,749.896,percent of total billed charges,35% of total billed charges for outpatient setting,2089,78,,1671.2,percent of total billed charges,78% of total billed charges for outpatient setting,1874.74,70,,1499.792,percent of total billed charges,70% of total billed charges for outpatient setting,1874.74,70,,1499.792,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2008.65,75,,1606.92,percent of total billed charges,75% of total billed charges for outpatient setting,2222.91,83,,1778.328,percent of total billed charges,83% of total billed charges for outpatient setting,4285.12,100,,,case rate,100% UHC case rate for outpatient setting,4285.12,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1049,39.17,,839.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,4285.12,
CT LUMBAR SPINE W/O CONTRAST,1430112,CDM,352,RC,72131,HCPCS,outpatient,,,638.4,319.2,,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,245.15,38.4,,196.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.15,38.4,,196.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,223.44,35,,178.752,percent of total billed charges,35% of total billed charges for outpatient setting,497.95,78,,398.36,percent of total billed charges,78% of total billed charges for outpatient setting,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,446.88,70,,357.504,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,478.8,75,,383.04,percent of total billed charges,75% of total billed charges for outpatient setting,529.87,83,,423.896,percent of total billed charges,83% of total billed charges for outpatient setting,1021.44,100,,,case rate,100% UHC case rate for outpatient setting,1021.44,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,250.05,39.17,,200.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1021.44,
CT PELVIS W/O CONTRA,1430113,CDM,352,RC,72192,HCPCS,outpatient,,,298.78,149.39,,209.15,70,,167.32,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,114.73,38.4,,91.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.73,38.4,,91.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.57,35,,83.656,percent of total billed charges,35% of total billed charges for outpatient setting,233.05,78,,186.44,percent of total billed charges,78% of total billed charges for outpatient setting,209.15,70,,167.32,percent of total billed charges,70% of total billed charges for outpatient setting,209.15,70,,167.32,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,224.09,75,,179.272,percent of total billed charges,75% of total billed charges for outpatient setting,247.99,83,,198.392,percent of total billed charges,83% of total billed charges for outpatient setting,478.05,100,,,case rate,100% UHC case rate for outpatient setting,478.05,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.02,39.17,,93.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,478.05,
CT PELVIS W/CONTRAST,1430114,CDM,352,RC,72193,HCPCS,outpatient,,,3767,1883.5,,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1318.45,35,,1054.76,percent of total billed charges,35% of total billed charges for outpatient setting,2938.26,78,,2350.608,percent of total billed charges,78% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2825.25,75,,2260.2,percent of total billed charges,75% of total billed charges for outpatient setting,3126.61,83,,2501.288,percent of total billed charges,83% of total billed charges for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1475.46,39.17,,1180.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,6027.2,
CT CHEST/ABD/PEL W/,1430115,CDM,352,RC,71260,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,400,
CT CHEST/ABD/PEL W/O,1430116,CDM,352,RC,71250,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,400,
CT CHEST/ABD W/O,1430117,CDM,352,RC,71250,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,400,
CT CHEST/ABD W/,1430118,CDM,352,RC,71250,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,400,
CT CHEST/ABD W/WO,1430119,CDM,352,RC,71250,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,400,
CT UPPER EXT W&WO CONT LEFT,1430120,CDM,352,RC,73202,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
CT ABDOMEN W/O CONTR,1430121,CDM,352,RC,74150,HCPCS,outpatient,,,364,182,,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.4,35,,101.92,percent of total billed charges,35% of total billed charges for outpatient setting,283.92,78,,227.136,percent of total billed charges,78% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,302.12,83,,241.696,percent of total billed charges,83% of total billed charges for outpatient setting,582.4,100,,,case rate,100% UHC case rate for outpatient setting,582.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.58,39.17,,114.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,582.4,
CT ABDOMEN W/CONTRA,1430122,CDM,352,RC,74160,HCPCS,outpatient,,,3767,1883.5,,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1446.53,38.4,,1157.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1318.45,35,,1054.76,percent of total billed charges,35% of total billed charges for outpatient setting,2938.26,78,,2350.608,percent of total billed charges,78% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,2636.9,70,,2109.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2825.25,75,,2260.2,percent of total billed charges,75% of total billed charges for outpatient setting,3126.61,83,,2501.288,percent of total billed charges,83% of total billed charges for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,6027.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1475.46,39.17,,1180.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,6027.2,
CT ABDOMEN W-W/O CON,1430123,CDM,352,RC,74170,HCPCS,outpatient,,,4242,2121,,2969.4,70,,2375.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1628.93,38.4,,1303.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1628.93,38.4,,1303.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1484.7,35,,1187.76,percent of total billed charges,35% of total billed charges for outpatient setting,3308.76,78,,2647.008,percent of total billed charges,78% of total billed charges for outpatient setting,2969.4,70,,2375.52,percent of total billed charges,70% of total billed charges for outpatient setting,2969.4,70,,2375.52,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3181.5,75,,2545.2,percent of total billed charges,75% of total billed charges for outpatient setting,3520.86,83,,2816.688,percent of total billed charges,83% of total billed charges for outpatient setting,6787.2,100,,,case rate,100% UHC case rate for outpatient setting,6787.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1661.51,39.17,,1329.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,6787.2,
CT LIMITED OR F/U (SINUSES),1430124,CDM,359,RC,76380,HCPCS,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,656,100,,,case rate,100% UHC case rate for outpatient setting,656,100,,,case rate,100% UHC case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,656,
CT LIMITED OR F/U STUDY,1430125,CDM,359,RC,76380,HCPCS,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,656,100,,,case rate,100% UHC case rate for outpatient setting,656,100,,,case rate,100% UHC case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,656,
CT STONE PROTOCOL,1430133,CDM,359,RC,74176,HCPCS,outpatient,,,1743,871.5,,1220.1,70,,976.08,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,669.31,38.4,,535.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,669.31,38.4,,535.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,610.05,35,,488.04,percent of total billed charges,35% of total billed charges for outpatient setting,1359.54,78,,1087.632,percent of total billed charges,78% of total billed charges for outpatient setting,1220.1,70,,976.08,percent of total billed charges,70% of total billed charges for outpatient setting,1220.1,70,,976.08,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1307.25,75,,1045.8,percent of total billed charges,75% of total billed charges for outpatient setting,1446.69,83,,1157.352,percent of total billed charges,83% of total billed charges for outpatient setting,2788.8,100,,,case rate,100% UHC case rate for outpatient setting,2788.8,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,682.7,39.17,,546.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,2788.8,
US BREAST UNILAT LT,1430134,CDM,402,RC,76641,HCPCS,outpatient,,,775.6,387.8,,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,297.83,38.4,,238.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.83,38.4,,238.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,138.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,271.46,35,,217.168,percent of total billed charges,35% of total billed charges for outpatient setting,604.97,78,,483.976,percent of total billed charges,78% of total billed charges for outpatient setting,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,542.92,70,,434.336,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,581.7,75,,465.36,percent of total billed charges,75% of total billed charges for outpatient setting,643.75,83,,515,percent of total billed charges,83% of total billed charges for outpatient setting,1240.96,100,,,case rate,100% UHC case rate for outpatient setting,1240.96,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,303.79,39.17,,243.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,1240.96,
US LIMITED,1430205,CDM,402,RC,76775,HCPCS,outpatient,,,144,72,,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,55.3,38.4,,44.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.3,38.4,,44.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,35,,40.32,percent of total billed charges,35% of total billed charges for outpatient setting,112.32,78,,89.856,percent of total billed charges,78% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,100.8,70,,80.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108,75,,86.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.52,83,,95.616,percent of total billed charges,83% of total billed charges for outpatient setting,230.4,100,,,case rate,100% UHC case rate for outpatient setting,230.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.41,39.17,,45.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.4,230.4,
US OF BACK,1450001,CDM,402,RC,76999,HCPCS,outpatient,,,186,93,,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.1,35,,52.08,percent of total billed charges,35% of total billed charges for outpatient setting,145.08,78,,116.064,percent of total billed charges,78% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.38,83,,123.504,percent of total billed charges,83% of total billed charges for outpatient setting,297.6,100,,,case rate,100% UHC case rate for outpatient setting,297.6,100,,,case rate,100% UHC case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.85,39.17,,58.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.1,297.6,
CONTRAST OPTI 320,1454452,CDM,636,RC,Q9967,HCPCS,both,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
CT GUIDE ABD BIOPSY,1470048,CDM,361,RC,49180,HCPCS,outpatient,,,3899,1949.5,,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1497.22,38.4,,1197.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1497.22,38.4,,1197.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,2924.25,75,,2339.4,percent of total billed charges,75% of total billed charges for outpatient setting,2924.25,75,,2339.4,percent of total billed charges,75% of total billed charges for outpatient setting,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,2924.25,75,,2339.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1364.65,35,,1091.72,percent of total billed charges,35% of total billed charges for outpatient setting,3041.22,78,,2432.976,percent of total billed charges,78% of total billed charges for outpatient setting,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,2729.3,70,,2183.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2924.25,75,,2339.4,percent of total billed charges,75% of total billed charges for outpatient setting,3236.17,83,,2588.936,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1527.16,39.17,,1221.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1364.65,3236.17,
CT 3D,1480001,CDM,350,RC,76376,HCPCS,outpatient,,,389,194.5,,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.38,38.4,,119.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.38,38.4,,119.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.15,35,,108.92,percent of total billed charges,35% of total billed charges for outpatient setting,303.42,78,,242.736,percent of total billed charges,78% of total billed charges for outpatient setting,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,272.3,70,,217.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,291.75,75,,233.4,percent of total billed charges,75% of total billed charges for outpatient setting,322.87,83,,258.296,percent of total billed charges,83% of total billed charges for outpatient setting,622.4,100,,,case rate,100% UHC case rate for outpatient setting,622.4,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.37,39.17,,121.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.15,622.4,
US PARACENTESIS GUIDE,1480014,CDM,402,RC,49083,HCPCS,outpatient,,,223,111.5,,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.63,38.4,,68.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,35,,62.44,percent of total billed charges,35% of total billed charges for outpatient setting,173.94,78,,139.152,percent of total billed charges,78% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,156.1,70,,124.88,percent of total billed charges,70% of total billed charges for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,167.25,75,,133.8,percent of total billed charges,75% of total billed charges for outpatient setting,185.09,83,,148.072,percent of total billed charges,83% of total billed charges for outpatient setting,356.8,100,,,case rate,100% UHC case rate for outpatient setting,356.8,100,,,case rate,100% UHC case rate for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.34,39.17,,69.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,778.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,778.65,
NM TC 99M SESTAMIBI/CARDIOLITE UP,1480015,CDM,636,RC,A9500,HCPCS,both,,,333,166.5,,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,127.87,38.4,,102.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.87,38.4,,102.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.55,35,,93.24,percent of total billed charges,35% of total billed charges for outpatient setting,259.74,78,,207.792,percent of total billed charges,78% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,276.39,83,,221.112,percent of total billed charges,83% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.43,39.17,,104.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.55,276.39,
NM THALLOUS CHLORIDE TL 201/MCI,1480016,CDM,636,RC,A9505,HCPCS,both,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,35,,26.04,percent of total billed charges,35% of total billed charges for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.42,39.17,,29.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.55,77.19,
NM N417156020105,1480017,CDM,636,RC,A9516,HCPCS,both,,,196,98,,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.26,38.4,,60.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.26,38.4,,60.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.6,35,,54.88,percent of total billed charges,35% of total billed charges for outpatient setting,152.88,78,,122.304,percent of total billed charges,78% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,162.68,83,,130.144,percent of total billed charges,83% of total billed charges for outpatient setting,98,50,,78.4,percent of total billed charges,50% of total billed charges for outpatient setting,98,50,,78.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.77,39.17,,61.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.6,162.68,
"NM TC 99M ALBUMIN AGGR/MAA, UP TO",1480018,CDM,636,RC,A9540,HCPCS,both,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
"NM TC 99M MEBROFENIN/CHOLETEC, UP",1480019,CDM,636,RC,A9537,HCPCS,both,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
"NM TC 99M SULFUR COLLOID, UP TO 2",1480020,CDM,636,RC,A9541,HCPCS,both,,,156,78,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.9,38.4,,47.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.9,38.4,,47.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.6,35,,43.68,percent of total billed charges,35% of total billed charges for outpatient setting,121.68,78,,97.344,percent of total billed charges,78% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,83,,103.584,percent of total billed charges,83% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,78,50,,62.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.1,39.17,,48.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.6,129.48,
"NM GA 67 GALLIUM, PER MCI",1480021,CDM,636,RC,A9556,HCPCS,both,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
"NM TC 99M LABELED RED BLOOD CELL,",1480022,CDM,636,RC,A9560,HCPCS,both,,,145,72.5,,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.75,35,,40.6,percent of total billed charges,35% of total billed charges for outpatient setting,113.1,78,,90.48,percent of total billed charges,78% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,120.35,83,,96.28,percent of total billed charges,83% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.79,39.17,,45.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,50.75,120.35,
NM TC 99M DISOFENIN HEPATOLITE UP,1480023,CDM,636,RC,A9510,HCPCS,both,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.65,35,,38.92,percent of total billed charges,35% of total billed charges for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.45,39.17,,43.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,48.65,115.37,
NM MUGA TC04,1480033,CDM,636,RC,A9512,HCPCS,both,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
NM TC 99M MDP UP TO 30 MILLICURIE,1480034,CDM,636,RC,A9503,HCPCS,both,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
NM TC 99M DTPA UP TO 25 MCI,1480035,CDM,636,RC,A9539,HCPCS,both,,,139,69.5,,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.38,38.4,,42.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.65,35,,38.92,percent of total billed charges,35% of total billed charges for outpatient setting,108.42,78,,86.736,percent of total billed charges,78% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,70,,77.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.25,75,,83.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.37,83,,92.296,percent of total billed charges,83% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,69.5,50,,55.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.45,39.17,,43.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,48.65,115.37,
NM TC04 GI BLEED,1480036,CDM,636,RC,A9512,HCPCS,both,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
NM MAG 3,1480037,CDM,636,RC,A9562,HCPCS,both,,,361,180.5,,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.62,38.4,,110.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.62,38.4,,110.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.75,75,,216.6,percent of total billed charges,75% of total billed charges for outpatient setting,270.75,75,,216.6,percent of total billed charges,75% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.75,75,,216.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.35,35,,101.08,percent of total billed charges,35% of total billed charges for outpatient setting,281.58,78,,225.264,percent of total billed charges,78% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,252.7,70,,202.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.75,75,,216.6,percent of total billed charges,75% of total billed charges for outpatient setting,299.63,83,,239.704,percent of total billed charges,83% of total billed charges for outpatient setting,180.5,50,,144.4,percent of total billed charges,50% of total billed charges for outpatient setting,180.5,50,,144.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141.39,39.17,,113.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,126.35,299.63,
CT TEMPORAL JOINT W&W/O CON,1488904,CDM,351,RC,70488,HCPCS,outpatient,,,1443,721.5,,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.11,38.4,,443.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,505.05,35,,404.04,percent of total billed charges,35% of total billed charges for outpatient setting,1125.54,78,,900.432,percent of total billed charges,78% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,1010.1,70,,808.08,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1082.25,75,,865.8,percent of total billed charges,75% of total billed charges for outpatient setting,1197.69,83,,958.152,percent of total billed charges,83% of total billed charges for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,2308.8,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,565.19,39.17,,452.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2308.8,
CT TEMPORAL JOINT W/CON,1488905,CDM,351,RC,70487,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,2051.2,100,,,case rate,100% UHC case rate for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,2051.2,
CT TEMPORAL W/O CON,1488906,CDM,351,RC,70486,HCPCS,outpatient,,,335,167.5,,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,128.64,38.4,,102.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.64,38.4,,102.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.25,35,,93.8,percent of total billed charges,35% of total billed charges for outpatient setting,261.3,78,,209.04,percent of total billed charges,78% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,251.25,75,,201,percent of total billed charges,75% of total billed charges for outpatient setting,278.05,83,,222.44,percent of total billed charges,83% of total billed charges for outpatient setting,536,100,,,case rate,100% UHC case rate for outpatient setting,536,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.21,39.17,,104.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,536,
CT CHEST LOW DOSE,1488907,CDM,352,RC,71271,HCPCS,outpatient,,,434,217,,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,166.66,38.4,,133.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.66,38.4,,133.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.9,35,,121.52,percent of total billed charges,35% of total billed charges for outpatient setting,338.52,78,,270.816,percent of total billed charges,78% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,303.8,70,,243.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,325.5,75,,260.4,percent of total billed charges,75% of total billed charges for outpatient setting,360.22,83,,288.176,percent of total billed charges,83% of total billed charges for outpatient setting,694.4,100,,,case rate,100% UHC case rate for outpatient setting,694.4,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,169.99,39.17,,135.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,694.4,
NM LIVER FLOW,1488913,CDM,320,RC,78202,HCPCS,outpatient,,,767,383.5,,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.53,38.4,,235.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,355.8,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.45,35,,214.76,percent of total billed charges,35% of total billed charges for outpatient setting,598.26,78,,478.608,percent of total billed charges,78% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,536.9,70,,429.52,percent of total billed charges,70% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,575.25,75,,460.2,percent of total billed charges,75% of total billed charges for outpatient setting,636.61,83,,509.288,percent of total billed charges,83% of total billed charges for outpatient setting,383.5,50,,306.8,percent of total billed charges,50% of total billed charges for outpatient setting,383.5,50,,306.8,percent of total billed charges,50% of total billed charges for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.42,39.17,,240.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,464.28,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.45,636.61,
NM MYOCARDIAL PERFUSION SINGLE,1488918,CDM,320,RC,78451,HCPCS,outpatient,,,2374,1187,,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,911.62,38.4,,729.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,911.62,38.4,,729.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,554.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,830.9,35,,664.72,percent of total billed charges,35% of total billed charges for outpatient setting,1851.72,78,,1481.376,percent of total billed charges,78% of total billed charges for outpatient setting,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,1661.8,70,,1329.44,percent of total billed charges,70% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1780.5,75,,1424.4,percent of total billed charges,75% of total billed charges for outpatient setting,1970.42,83,,1576.336,percent of total billed charges,83% of total billed charges for outpatient setting,1187,50,,949.6,percent of total billed charges,50% of total billed charges for outpatient setting,1187,50,,949.6,percent of total billed charges,50% of total billed charges for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,929.85,39.17,,743.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1219.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.23,1970.42,
CT ABDOMEN/PELVIS W/O CONTRAST,1488919,CDM,350,RC,74176,HCPCS,outpatient,,,3088.2,1544.1,,2161.74,70,,1729.392,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1185.87,38.4,,948.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1185.87,38.4,,948.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1080.87,35,,864.696,percent of total billed charges,35% of total billed charges for outpatient setting,2408.8,78,,1927.04,percent of total billed charges,78% of total billed charges for outpatient setting,2161.74,70,,1729.392,percent of total billed charges,70% of total billed charges for outpatient setting,2161.74,70,,1729.392,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2316.15,75,,1852.92,percent of total billed charges,75% of total billed charges for outpatient setting,2563.21,83,,2050.568,percent of total billed charges,83% of total billed charges for outpatient setting,4941.12,100,,,case rate,100% UHC case rate for outpatient setting,4941.12,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1209.59,39.17,,967.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,4941.12,
CT ABDOMEN/PELVIS W/CONTRAST,1488920,CDM,350,RC,74177,HCPCS,outpatient,,,8262.8,4131.4,,5783.96,70,,4627.168,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3172.92,38.4,,2538.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3172.92,38.4,,2538.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2891.98,35,,2313.584,percent of total billed charges,35% of total billed charges for outpatient setting,6444.98,78,,5155.984,percent of total billed charges,78% of total billed charges for outpatient setting,5783.96,70,,4627.168,percent of total billed charges,70% of total billed charges for outpatient setting,5783.96,70,,4627.168,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6197.1,75,,4957.68,percent of total billed charges,75% of total billed charges for outpatient setting,6858.12,83,,5486.496,percent of total billed charges,83% of total billed charges for outpatient setting,13220.48,100,,,case rate,100% UHC case rate for outpatient setting,13220.48,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3236.38,39.17,,2589.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,13220.48,
CT ABDOMEN/PELVIS W &W/O CONTR,1488921,CDM,350,RC,74178,HCPCS,outpatient,,,2372.48,1186.24,,1660.74,70,,1328.592,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,911.03,38.4,,728.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,911.03,38.4,,728.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,400,100,,,case rate,100% Anthem CT case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,830.37,35,,664.296,percent of total billed charges,35% of total billed charges for outpatient setting,1850.53,78,,1480.424,percent of total billed charges,78% of total billed charges for outpatient setting,1660.74,70,,1328.592,percent of total billed charges,70% of total billed charges for outpatient setting,1660.74,70,,1328.592,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1779.36,75,,1423.488,percent of total billed charges,75% of total billed charges for outpatient setting,1969.16,83,,1575.328,percent of total billed charges,83% of total billed charges for outpatient setting,3795.97,100,,,case rate,100% UHC case rate for outpatient setting,3795.97,100,,,case rate,100% UHC case rate for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,929.25,39.17,,743.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,3795.97,
US EXT NONVAS,1488922,CDM,402,RC,76882,HCPCS,outpatient,,,286,143,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,64.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.1,35,,80.08,percent of total billed charges,35% of total billed charges for outpatient setting,223.08,78,,178.464,percent of total billed charges,78% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,237.38,83,,189.904,percent of total billed charges,83% of total billed charges for outpatient setting,457.6,100,,,case rate,100% UHC case rate for outpatient setting,457.6,100,,,case rate,100% UHC case rate for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.02,39.17,,89.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.62,457.6,
US MASS/NODULE,1488924,CDM,402,RC,76999,HCPCS,outpatient,,,260,130,,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,99.84,38.4,,79.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.84,38.4,,79.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91,35,,72.8,percent of total billed charges,35% of total billed charges for outpatient setting,202.8,78,,162.24,percent of total billed charges,78% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,83,,172.64,percent of total billed charges,83% of total billed charges for outpatient setting,416,100,,,case rate,100% UHC case rate for outpatient setting,416,100,,,case rate,100% UHC case rate for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.84,39.17,,81.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,416,
"NM THYROID UPTAKE,SINGLE OR MULT,",1488926,CDM,341,RC,78012,HCPCS,outpatient,,,608,304,,425.6,70,,340.48,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,233.47,38.4,,186.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.47,38.4,,186.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,144.35,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.8,35,,170.24,percent of total billed charges,35% of total billed charges for outpatient setting,474.24,78,,379.392,percent of total billed charges,78% of total billed charges for outpatient setting,425.6,70,,340.48,percent of total billed charges,70% of total billed charges for outpatient setting,425.6,70,,340.48,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456,75,,364.8,percent of total billed charges,75% of total billed charges for outpatient setting,504.64,83,,403.712,percent of total billed charges,83% of total billed charges for outpatient setting,972.8,100,,,case rate,100% UHC case rate for outpatient setting,972.8,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.14,39.17,,190.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.35,972.8,
NM THYROID IMAGING(VASC FLOW),1488927,CDM,341,RC,78013,HCPCS,outpatient,,,469,234.5,,328.3,70,,262.64,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,180.1,38.4,,144.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.1,38.4,,144.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,351.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.15,35,,131.32,percent of total billed charges,35% of total billed charges for outpatient setting,365.82,78,,292.656,percent of total billed charges,78% of total billed charges for outpatient setting,328.3,70,,262.64,percent of total billed charges,70% of total billed charges for outpatient setting,328.3,70,,262.64,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.75,75,,281.4,percent of total billed charges,75% of total billed charges for outpatient setting,389.27,83,,311.416,percent of total billed charges,83% of total billed charges for outpatient setting,750.4,100,,,case rate,100% UHC case rate for outpatient setting,750.4,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.7,39.17,,146.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.15,750.4,
NM PARATHYROID PLANAR W/SPECT,1488928,CDM,341,RC,78071,HCPCS,outpatient,,,2086,1043,,1460.2,70,,1168.16,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,801.02,38.4,,640.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,801.02,38.4,,640.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,604.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,730.1,35,,584.08,percent of total billed charges,35% of total billed charges for outpatient setting,1627.08,78,,1301.664,percent of total billed charges,78% of total billed charges for outpatient setting,1460.2,70,,1168.16,percent of total billed charges,70% of total billed charges for outpatient setting,1460.2,70,,1168.16,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1564.5,75,,1251.6,percent of total billed charges,75% of total billed charges for outpatient setting,1731.38,83,,1385.104,percent of total billed charges,83% of total billed charges for outpatient setting,3337.6,100,,,case rate,100% UHC case rate for outpatient setting,3337.6,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,817.04,39.17,,653.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,3337.6,
NM PARA THYROID ADD PLANAR IMAGIN,1488929,CDM,341,RC,78070,HCPCS,outpatient,,,737,368.5,,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.01,38.4,,226.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.01,38.4,,226.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,528.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.95,35,,206.36,percent of total billed charges,35% of total billed charges for outpatient setting,574.86,78,,459.888,percent of total billed charges,78% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,515.9,70,,412.72,percent of total billed charges,70% of total billed charges for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,552.75,75,,442.2,percent of total billed charges,75% of total billed charges for outpatient setting,611.71,83,,489.368,percent of total billed charges,83% of total billed charges for outpatient setting,1179.2,100,,,case rate,100% UHC case rate for outpatient setting,1179.2,100,,,case rate,100% UHC case rate for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,288.67,39.17,,230.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,354.27,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.95,1179.2,
CONTRAST OPTI 350,1488932,CDM,636,RC,Q9967,HCPCS,both,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
XR CAD SCR /MAMMO,1500019,CDM,403,RC,77067,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,28.8,100,,,case rate,100% UHC case rate for outpatient setting,28.8,100,,,case rate,100% UHC case rate for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.3,193.62,
XR CAD DIAG/MAMMO,1500020,CDM,401,RC,77065,HCPCS,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,28.8,100,,,case rate,100% UHC case rate for outpatient setting,28.8,100,,,case rate,100% UHC case rate for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.3,183.32,
XR CORE BIOPSY PROCEDURE,1500034,CDM,361,RC,19102,HCPCS,outpatient,,,302,151,,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.97,38.4,,92.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.97,38.4,,92.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,226.5,75,,181.2,percent of total billed charges,75% of total billed charges for outpatient setting,226.5,75,,181.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,226.5,75,,181.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.7,35,,84.56,percent of total billed charges,35% of total billed charges for outpatient setting,235.56,78,,188.448,percent of total billed charges,78% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,226.5,75,,181.2,percent of total billed charges,75% of total billed charges for outpatient setting,250.66,83,,200.528,percent of total billed charges,83% of total billed charges for outpatient setting,151,50,,120.8,percent of total billed charges,50% of total billed charges for outpatient setting,151,50,,120.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,118.29,39.17,,94.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,105.7,250.66,
XR CHEST 4 VIEWS,1500039,CDM,320,RC,71048,HCPCS,outpatient,,,101,50.5,,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,38.78,38.4,,31.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.78,38.4,,31.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.35,35,,28.28,percent of total billed charges,35% of total billed charges for outpatient setting,78.78,78,,63.024,percent of total billed charges,78% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,70.7,70,,56.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.75,75,,60.6,percent of total billed charges,75% of total billed charges for outpatient setting,83.83,83,,67.064,percent of total billed charges,83% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,50.5,50,,40.4,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.56,39.17,,31.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.35,94.43,
RF ENEMA-THERAPEUTIC,1500040,CDM,320,RC,74283,HCPCS,outpatient,,,510,255,,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,206.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.5,35,,142.8,percent of total billed charges,35% of total billed charges for outpatient setting,397.8,78,,318.24,percent of total billed charges,78% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,423.3,83,,338.64,percent of total billed charges,83% of total billed charges for outpatient setting,255,50,,204,percent of total billed charges,50% of total billed charges for outpatient setting,255,50,,204,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.76,39.17,,159.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,423.3,
XR DIG BIL SCREENING MAMMO/CAD,1500043,CDM,403,RC,G0202,HCPCS,outpatient,,,239,119.5,,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.78,38.4,,73.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.78,38.4,,73.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.65,35,,66.92,percent of total billed charges,35% of total billed charges for outpatient setting,186.42,78,,149.136,percent of total billed charges,78% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,167.3,70,,133.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,179.25,75,,143.4,percent of total billed charges,75% of total billed charges for outpatient setting,198.37,83,,158.696,percent of total billed charges,83% of total billed charges for outpatient setting,382.4,100,,,case rate,100% UHC case rate for outpatient setting,382.4,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.62,39.17,,74.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,83.65,382.4,
XR DIG UNIL DIAGNOSTIC W/CAD,1500044,CDM,401,RC,G0206,HCPCS,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,260.8,100,,,case rate,100% UHC case rate for outpatient setting,260.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.05,260.8,
XR BIL DIG MAMMO W/O CAD,1500045,CDM,401,RC,G0204,HCPCS,outpatient,,,290,145,,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.5,35,,81.2,percent of total billed charges,35% of total billed charges for outpatient setting,226.2,78,,180.96,percent of total billed charges,78% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,240.7,83,,192.56,percent of total billed charges,83% of total billed charges for outpatient setting,464,100,,,case rate,100% UHC case rate for outpatient setting,464,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.59,39.17,,90.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,101.5,464,
XR UNIL MAMMO DIA W/O CAD,1500046,CDM,401,RC,G0206,HCPCS,outpatient,,,228,114,,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.55,38.4,,70.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.55,38.4,,70.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,171,75,,136.8,percent of total billed charges,75% of total billed charges for outpatient setting,171,75,,136.8,percent of total billed charges,75% of total billed charges for outpatient setting,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,171,75,,136.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.8,35,,63.84,percent of total billed charges,35% of total billed charges for outpatient setting,177.84,78,,142.272,percent of total billed charges,78% of total billed charges for outpatient setting,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,159.6,70,,127.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,171,75,,136.8,percent of total billed charges,75% of total billed charges for outpatient setting,189.24,83,,151.392,percent of total billed charges,83% of total billed charges for outpatient setting,364.8,100,,,case rate,100% UHC case rate for outpatient setting,364.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.3,39.17,,71.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,79.8,364.8,
XR PUNCH BIOPSY SKIN,1500049,CDM,360,RC,11100,HCPCS,outpatient,,,295,147.5,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.25,35,,82.6,percent of total billed charges,35% of total billed charges for outpatient setting,230.1,78,,184.08,percent of total billed charges,78% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,244.85,83,,195.88,percent of total billed charges,83% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.55,39.17,,92.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,103.25,244.85,
RF LUMBAR PUNCTURE DIAGNOSTIC,1500051,CDM,361,RC,62270,HCPCS,outpatient,,,1272,636,,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,488.45,38.4,,390.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,488.45,38.4,,390.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,954,75,,763.2,percent of total billed charges,75% of total billed charges for outpatient setting,954,75,,763.2,percent of total billed charges,75% of total billed charges for outpatient setting,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,954,75,,763.2,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,445.2,35,,356.16,percent of total billed charges,35% of total billed charges for outpatient setting,992.16,78,,793.728,percent of total billed charges,78% of total billed charges for outpatient setting,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,890.4,70,,712.32,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,954,75,,763.2,percent of total billed charges,75% of total billed charges for outpatient setting,1055.76,83,,844.608,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,498.22,39.17,,398.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,445.2,1452,
MM DIGITAL SCREENING MAMMO/CAD BILATERAL,1500054,CDM,403,RC,77067,HCPCS,outpatient,,,266,133,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,80.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,193.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.1,35,,74.48,percent of total billed charges,35% of total billed charges for outpatient setting,207.48,78,,165.984,percent of total billed charges,78% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,220.78,83,,176.624,percent of total billed charges,83% of total billed charges for outpatient setting,425.6,100,,,case rate,100% UHC case rate for outpatient setting,425.6,100,,,case rate,100% UHC case rate for outpatient setting,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.18,39.17,,83.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,80.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.16,425.6,
MM DIAGNOSTIC MAMMO/CAD BILATERAL,1500055,CDM,401,RC,77066,HCPCS,outpatient,,,317.8,158.9,,222.46,70,,177.968,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.04,38.4,,97.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.04,38.4,,97.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,234.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.23,35,,88.984,percent of total billed charges,35% of total billed charges for outpatient setting,247.88,78,,198.304,percent of total billed charges,78% of total billed charges for outpatient setting,222.46,70,,177.968,percent of total billed charges,70% of total billed charges for outpatient setting,222.46,70,,177.968,percent of total billed charges,70% of total billed charges for outpatient setting,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.35,75,,190.68,percent of total billed charges,75% of total billed charges for outpatient setting,263.77,83,,211.016,percent of total billed charges,83% of total billed charges for outpatient setting,508.48,100,,,case rate,100% UHC case rate for outpatient setting,508.48,100,,,case rate,100% UHC case rate for outpatient setting,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.48,39.17,,99.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,97.3,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,508.48,
MM DIAGNOSTIC MAMMO/CAD UNILATERAL,1500056,CDM,401,RC,77065,HCPCS,outpatient,,,153.61,76.81,,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,75.83,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.99,38.4,,47.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.99,38.4,,47.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,183.32,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.76,35,,43.008,percent of total billed charges,35% of total billed charges for outpatient setting,119.82,78,,95.856,percent of total billed charges,78% of total billed charges for outpatient setting,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,107.53,70,,86.024,percent of total billed charges,70% of total billed charges for outpatient setting,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.21,75,,92.168,percent of total billed charges,75% of total billed charges for outpatient setting,127.5,83,,102,percent of total billed charges,83% of total billed charges for outpatient setting,245.78,100,,,case rate,100% UHC case rate for outpatient setting,245.78,100,,,case rate,100% UHC case rate for outpatient setting,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.17,39.17,,48.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,75.83,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.76,245.78,
MM TOMO SCREENING MAMMO BILATERAL,1500057,CDM,403,RC,77063,HCPCS,outpatient,,,106.4,53.2,,74.48,70,,59.584,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,40.86,38.4,,32.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.86,38.4,,32.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.72,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.24,35,,29.792,percent of total billed charges,35% of total billed charges for outpatient setting,82.99,78,,66.392,percent of total billed charges,78% of total billed charges for outpatient setting,74.48,70,,59.584,percent of total billed charges,70% of total billed charges for outpatient setting,74.48,70,,59.584,percent of total billed charges,70% of total billed charges for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.8,75,,63.84,percent of total billed charges,75% of total billed charges for outpatient setting,88.31,83,,70.648,percent of total billed charges,83% of total billed charges for outpatient setting,170.24,100,,,case rate,100% UHC case rate for outpatient setting,170.24,100,,,case rate,100% UHC case rate for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.68,39.17,,33.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,20.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.81,170.24,
MM TOMO DIAGNOSTIC BILATERAL MAMMO,1500058,CDM,401,RC,77062,HCPCS,outpatient,,,372.2,186.1,,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.92,38.4,,114.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.92,38.4,,114.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,279.15,75,,223.32,percent of total billed charges,75% of total billed charges for outpatient setting,279.15,75,,223.32,percent of total billed charges,75% of total billed charges for outpatient setting,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,279.15,75,,223.32,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.27,35,,104.216,percent of total billed charges,35% of total billed charges for outpatient setting,290.32,78,,232.256,percent of total billed charges,78% of total billed charges for outpatient setting,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,260.54,70,,208.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279.15,75,,223.32,percent of total billed charges,75% of total billed charges for outpatient setting,308.93,83,,247.144,percent of total billed charges,83% of total billed charges for outpatient setting,595.52,100,,,case rate,100% UHC case rate for outpatient setting,595.52,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.78,39.17,,116.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,130.27,595.52,
MM TOMO DIAGNOSTIC UNILATERAL MAMMO,1500059,CDM,401,RC,77061,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.3,35,,72.24,percent of total billed charges,35% of total billed charges for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,412.8,100,,,case rate,100% UHC case rate for outpatient setting,412.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.05,39.17,,80.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,90.3,412.8,
XR ABDOMEN FLAT/KUB,1510001,CDM,320,RC,74018,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.13,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.13,175.13,
XR ABD FLAT/UPRIGHT,1510003,CDM,320,RC,74019,HCPCS,outpatient,,,127.4,63.7,,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.59,35,,35.672,percent of total billed charges,35% of total billed charges for outpatient setting,99.37,78,,79.496,percent of total billed charges,78% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,105.74,83,,84.592,percent of total billed charges,83% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.9,39.17,,39.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.98,105.74,
XR ABDOMEN FLAT/DECUB,1510005,CDM,320,RC,74019,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,94.43,
XR ABDOMINAL SERIES,1510007,CDM,320,RC,74022,HCPCS,outpatient,,,398.37,199.19,,278.86,70,,223.088,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,152.97,38.4,,122.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.97,38.4,,122.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,139.43,35,,111.544,percent of total billed charges,35% of total billed charges for outpatient setting,310.73,78,,248.584,percent of total billed charges,78% of total billed charges for outpatient setting,278.86,70,,223.088,percent of total billed charges,70% of total billed charges for outpatient setting,278.86,70,,223.088,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,298.78,75,,239.024,percent of total billed charges,75% of total billed charges for outpatient setting,330.65,83,,264.52,percent of total billed charges,83% of total billed charges for outpatient setting,199.19,50,,159.352,percent of total billed charges,50% of total billed charges for outpatient setting,199.19,50,,159.352,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.03,39.17,,124.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.01,330.65,
XR ACROMIO-CLAVICULAR BILATERAL,1510009,CDM,320,RC,73050,HCPCS,outpatient,,,166,83,,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,63.74,38.4,,50.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.74,38.4,,50.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.1,35,,46.48,percent of total billed charges,35% of total billed charges for outpatient setting,129.48,78,,103.584,percent of total billed charges,78% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.78,83,,110.224,percent of total billed charges,83% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.01,39.17,,52.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,137.78,
XR ANKLE AP LAT LEFT,1510011,CDM,320,RC,73600,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.3,288.84,
RF BARIUM ENEMA,1510013,CDM,320,RC,74270,HCPCS,outpatient,,,914,457,,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,223.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.9,35,,255.92,percent of total billed charges,35% of total billed charges for outpatient setting,712.92,78,,570.336,percent of total billed charges,78% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,685.5,75,,548.4,percent of total billed charges,75% of total billed charges for outpatient setting,758.62,83,,606.896,percent of total billed charges,83% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,358,39.17,,286.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,758.62,
RF BARIUM ENEMA W AIR,1510015,CDM,320,RC,74280,HCPCS,outpatient,,,510,255,,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,316.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.5,35,,142.8,percent of total billed charges,35% of total billed charges for outpatient setting,397.8,78,,318.24,percent of total billed charges,78% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,423.3,83,,338.64,percent of total billed charges,83% of total billed charges for outpatient setting,255,50,,204,percent of total billed charges,50% of total billed charges for outpatient setting,255,50,,204,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.76,39.17,,159.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,423.3,
XR SKELETAL SURVEY,1510021,CDM,320,RC,77075,HCPCS,outpatient,,,210,105,,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,35,,58.8,percent of total billed charges,35% of total billed charges for outpatient setting,163.8,78,,131.04,percent of total billed charges,78% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,83,,139.44,percent of total billed charges,83% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.25,39.17,,65.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,174.3,
XR CERVICAL SP/OBL,1510024,CDM,320,RC,72050,HCPCS,outpatient,,,772.8,386.4,,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270.48,35,,216.384,percent of total billed charges,35% of total billed charges for outpatient setting,602.78,78,,482.224,percent of total billed charges,78% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,579.6,75,,463.68,percent of total billed charges,75% of total billed charges for outpatient setting,641.42,83,,513.136,percent of total billed charges,83% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,302.7,39.17,,242.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,641.42,
XR CERVICAL SPINE LIMIT,1510025,CDM,320,RC,72040,HCPCS,outpatient,,,644,322,,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,225.4,35,,180.32,percent of total billed charges,35% of total billed charges for outpatient setting,502.32,78,,401.856,percent of total billed charges,78% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.52,83,,427.616,percent of total billed charges,83% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.25,39.17,,201.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.68,534.52,
XR CERVICAL COMPLETE W/FLEX/EXT,1510026,CDM,320,RC,72052,HCPCS,outpatient,,,465.89,232.95,,326.12,70,,260.896,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,178.9,38.4,,143.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.9,38.4,,143.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,72.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.06,35,,130.448,percent of total billed charges,35% of total billed charges for outpatient setting,363.39,78,,290.712,percent of total billed charges,78% of total billed charges for outpatient setting,326.12,70,,260.896,percent of total billed charges,70% of total billed charges for outpatient setting,326.12,70,,260.896,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,349.42,75,,279.536,percent of total billed charges,75% of total billed charges for outpatient setting,386.69,83,,309.352,percent of total billed charges,83% of total billed charges for outpatient setting,232.95,50,,186.36,percent of total billed charges,50% of total billed charges for outpatient setting,232.95,50,,186.36,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.48,39.17,,145.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.86,386.69,
XR CHEST PA,1510028,CDM,320,RC,71045,HCPCS,outpatient,,,76.45,38.23,,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.36,38.4,,23.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.36,38.4,,23.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,20.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.76,35,,21.408,percent of total billed charges,35% of total billed charges for outpatient setting,59.63,78,,47.704,percent of total billed charges,78% of total billed charges for outpatient setting,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.34,75,,45.872,percent of total billed charges,75% of total billed charges for outpatient setting,63.45,83,,50.76,percent of total billed charges,83% of total billed charges for outpatient setting,38.23,50,,30.584,percent of total billed charges,50% of total billed charges for outpatient setting,38.23,50,,30.584,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.95,39.17,,23.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.71,78.05,
XR CHEST PA & LATERAL,1510030,CDM,320,RC,71046,HCPCS,outpatient,,,418.6,209.3,,293.02,70,,234.416,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,160.74,38.4,,128.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.74,38.4,,128.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.51,35,,117.208,percent of total billed charges,35% of total billed charges for outpatient setting,326.51,78,,261.208,percent of total billed charges,78% of total billed charges for outpatient setting,293.02,70,,234.416,percent of total billed charges,70% of total billed charges for outpatient setting,293.02,70,,234.416,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,313.95,75,,251.16,percent of total billed charges,75% of total billed charges for outpatient setting,347.44,83,,277.952,percent of total billed charges,83% of total billed charges for outpatient setting,209.3,50,,167.44,percent of total billed charges,50% of total billed charges for outpatient setting,209.3,50,,167.44,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.95,39.17,,131.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.86,347.44,
XR CHEST W OBL/FLURO,1510032,CDM,320,RC,71034,HCPCS,outpatient,,,323,161.5,,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.05,35,,90.44,percent of total billed charges,35% of total billed charges for outpatient setting,251.94,78,,201.552,percent of total billed charges,78% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.09,83,,214.472,percent of total billed charges,83% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.51,39.17,,101.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,113.05,268.09,
XR CHECK TUBE FOR PATENCY/PLACEME,1510033,CDM,320,RC,76080,HCPCS,outpatient,,,328,164,,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.8,35,,91.84,percent of total billed charges,35% of total billed charges for outpatient setting,255.84,78,,204.672,percent of total billed charges,78% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,272.24,83,,217.792,percent of total billed charges,83% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.47,39.17,,102.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.71,473.87,
XR CLAVICLE LEFT,1510034,CDM,320,RC,73000,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.86,288.84,
RF CYSTOURETHROGRAPHY,1510041,CDM,320,RC,74455,HCPCS,outpatient,,,530,265,,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,35,,148.4,percent of total billed charges,35% of total billed charges for outpatient setting,413.4,78,,330.72,percent of total billed charges,78% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,397.5,75,,318,percent of total billed charges,75% of total billed charges for outpatient setting,439.9,83,,351.92,percent of total billed charges,83% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.59,39.17,,166.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,127.75,439.9,
RF CHEST FLUORO,1510043,CDM,320,RC,76000,HCPCS,outpatient,,,323,161.5,,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.05,35,,90.44,percent of total billed charges,35% of total billed charges for outpatient setting,251.94,78,,201.552,percent of total billed charges,78% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.09,83,,214.472,percent of total billed charges,83% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.51,39.17,,101.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,268.09,
XR ELBOW 3 VIEWS LEFT,1510047,CDM,320,RC,73080,HCPCS,outpatient,,,293.71,146.86,,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.8,35,,82.24,percent of total billed charges,35% of total billed charges for outpatient setting,229.09,78,,183.272,percent of total billed charges,78% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,220.28,75,,176.224,percent of total billed charges,75% of total billed charges for outpatient setting,243.78,83,,195.024,percent of total billed charges,83% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.04,39.17,,92.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,243.78,
RF BA-SWALLOW ESOPHAGRA,1510049,CDM,320,RC,74220,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,126.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,175.13,
XR FACIAL BONES,1510050,CDM,320,RC,70150,HCPCS,outpatient,,,394,197,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.9,35,,110.32,percent of total billed charges,35% of total billed charges for outpatient setting,307.32,78,,245.856,percent of total billed charges,78% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,327.02,83,,261.616,percent of total billed charges,83% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.33,39.17,,123.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.34,327.02,
RF MODIFIED BA SWALLOW,1510051,CDM,320,RC,74230,HCPCS,outpatient,,,305,152.5,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,117.12,38.4,,93.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.12,38.4,,93.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,198.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.75,35,,85.4,percent of total billed charges,35% of total billed charges for outpatient setting,237.9,78,,190.32,percent of total billed charges,78% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,228.75,75,,183,percent of total billed charges,75% of total billed charges for outpatient setting,253.15,83,,202.52,percent of total billed charges,83% of total billed charges for outpatient setting,152.5,50,,122,percent of total billed charges,50% of total billed charges for outpatient setting,152.5,50,,122,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.46,39.17,,95.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.75,253.15,
XR FEMUR LEFT,1510052,CDM,320,RC,73552,HCPCS,outpatient,,,350,175,,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.5,35,,98,percent of total billed charges,35% of total billed charges for outpatient setting,273,78,,218.4,percent of total billed charges,78% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,290.5,83,,232.4,percent of total billed charges,83% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.09,39.17,,109.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.41,290.5,
XR FINGER/LEFT HAND THUMB,1510054,CDM,320,RC,73140,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,288.84,
XR FOOT LEFT,1510056,CDM,320,RC,73630,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.62,404.38,
XR FOREARM LEFT,1510058,CDM,320,RC,73090,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,404.38,
XR SOFT TISSUE NECK,1510066,CDM,320,RC,70360,HCPCS,outpatient,,,299,149.5,,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.65,35,,83.72,percent of total billed charges,35% of total billed charges for outpatient setting,233.22,78,,186.576,percent of total billed charges,78% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,248.17,83,,198.536,percent of total billed charges,83% of total billed charges for outpatient setting,149.5,50,,119.6,percent of total billed charges,50% of total billed charges for outpatient setting,149.5,50,,119.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.12,39.17,,93.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.56,248.17,
XR G I W BARIUM SWALLOW,1510072,CDM,320,RC,74240,HCPCS,outpatient,,,888,444,,621.6,70,,497.28,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,340.99,38.4,,272.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,340.99,38.4,,272.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,310.8,35,,248.64,percent of total billed charges,35% of total billed charges for outpatient setting,692.64,78,,554.112,percent of total billed charges,78% of total billed charges for outpatient setting,621.6,70,,497.28,percent of total billed charges,70% of total billed charges for outpatient setting,621.6,70,,497.28,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,666,75,,532.8,percent of total billed charges,75% of total billed charges for outpatient setting,737.04,83,,589.632,percent of total billed charges,83% of total billed charges for outpatient setting,444,50,,355.2,percent of total billed charges,50% of total billed charges for outpatient setting,444,50,,355.2,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,347.81,39.17,,278.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.07,737.04,
XR RIBS BILATERAL,1510074,CDM,320,RC,71110,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,109.56,
RF GI W SMALL BOWEL SERIES,1510075,CDM,320,RC,74240,HCPCS,outpatient,,,914,457,,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.9,35,,255.92,percent of total billed charges,35% of total billed charges for outpatient setting,712.92,78,,570.336,percent of total billed charges,78% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,685.5,75,,548.4,percent of total billed charges,75% of total billed charges for outpatient setting,758.62,83,,606.896,percent of total billed charges,83% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,358,39.17,,286.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.07,758.62,
XR HAND LEFT,1510077,CDM,320,RC,73130,HCPCS,outpatient,,,293.71,146.86,,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.8,35,,82.24,percent of total billed charges,35% of total billed charges for outpatient setting,229.09,78,,183.272,percent of total billed charges,78% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,220.28,75,,176.224,percent of total billed charges,75% of total billed charges for outpatient setting,243.78,83,,195.024,percent of total billed charges,83% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.04,39.17,,92.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.73,243.78,
XR HIP AP UNILATERAL LEFT,1510078,CDM,320,RC,73502,HCPCS,outpatient,,,274.3,137.15,,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,105.33,38.4,,84.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.33,38.4,,84.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.01,35,,76.808,percent of total billed charges,35% of total billed charges for outpatient setting,213.95,78,,171.16,percent of total billed charges,78% of total billed charges for outpatient setting,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.73,75,,164.584,percent of total billed charges,75% of total billed charges for outpatient setting,227.67,83,,182.136,percent of total billed charges,83% of total billed charges for outpatient setting,137.15,50,,109.72,percent of total billed charges,50% of total billed charges for outpatient setting,137.15,50,,109.72,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.44,39.17,,85.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.45,227.67,
XR HIP AP LAT & PELVIS BILATERAL,1510079,CDM,320,RC,73523,HCPCS,outpatient,,,730.06,365.03,,511.04,70,,408.832,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,280.34,38.4,,224.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,280.34,38.4,,224.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.36,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,255.52,35,,204.416,percent of total billed charges,35% of total billed charges for outpatient setting,569.45,78,,455.56,percent of total billed charges,78% of total billed charges for outpatient setting,511.04,70,,408.832,percent of total billed charges,70% of total billed charges for outpatient setting,511.04,70,,408.832,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,547.55,75,,438.04,percent of total billed charges,75% of total billed charges for outpatient setting,605.95,83,,484.76,percent of total billed charges,83% of total billed charges for outpatient setting,365.03,50,,292.024,percent of total billed charges,50% of total billed charges for outpatient setting,365.03,50,,292.024,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.95,39.17,,228.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.36,605.95,
XR LUMBOSACRAL SP INDUS,1510082,CDM,320,RC,72100,HCPCS,outpatient,,,166.6,83.3,,116.62,70,,93.296,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,63.97,38.4,,51.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.97,38.4,,51.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.31,35,,46.648,percent of total billed charges,35% of total billed charges for outpatient setting,129.95,78,,103.96,percent of total billed charges,78% of total billed charges for outpatient setting,116.62,70,,93.296,percent of total billed charges,70% of total billed charges for outpatient setting,116.62,70,,93.296,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.95,75,,99.96,percent of total billed charges,75% of total billed charges for outpatient setting,138.28,83,,110.624,percent of total billed charges,83% of total billed charges for outpatient setting,83.3,50,,66.64,percent of total billed charges,50% of total billed charges for outpatient setting,83.3,50,,66.64,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,39.17,,52.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,138.28,
XR HUMERUS LEFT,1510083,CDM,320,RC,73060,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,81.34,
XR I V P BOLUS/INF,1510087,CDM,320,RC,74410,HCPCS,outpatient,,,266,133,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,167.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.1,35,,74.48,percent of total billed charges,35% of total billed charges for outpatient setting,207.48,78,,165.984,percent of total billed charges,78% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,220.78,83,,176.624,percent of total billed charges,83% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.18,39.17,,83.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.1,220.78,
XR KNEE 3 VIEWS LEFT,1510093,CDM,320,RC,73562,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.9,404.38,
XR CHEST W/APICAL,1510097,CDM,320,RC,71047,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR LUMBOSACRAL SPINE W/ OBLIQUE,1510098,CDM,320,RC,72110,HCPCS,outpatient,,,772.8,386.4,,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,63.94,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270.48,35,,216.384,percent of total billed charges,35% of total billed charges for outpatient setting,602.78,78,,482.224,percent of total billed charges,78% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,579.6,75,,463.68,percent of total billed charges,75% of total billed charges for outpatient setting,641.42,83,,513.136,percent of total billed charges,83% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,302.7,39.17,,242.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.94,641.42,
XR LUMBOSACRAL SPINE,1510099,CDM,320,RC,72100,HCPCS,outpatient,,,644,322,,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,225.4,35,,180.32,percent of total billed charges,35% of total billed charges for outpatient setting,502.32,78,,401.856,percent of total billed charges,78% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.52,83,,427.616,percent of total billed charges,83% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.25,39.17,,201.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,534.52,
XR MANDIBLE COMPLETE,1510104,CDM,320,RC,70110,HCPCS,outpatient,,,394,197,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.9,35,,110.32,percent of total billed charges,35% of total billed charges for outpatient setting,307.32,78,,245.856,percent of total billed charges,78% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,327.02,83,,261.616,percent of total billed charges,83% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.33,39.17,,123.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,327.02,
XR MASTOIDS BILATERAL,1510108,CDM,320,RC,70130,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,71.49,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,109.56,
XR NASAL BONES,1510116,CDM,320,RC,70160,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.79,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.79,288.84,
RF CHOLANGIOGRAPHY,1510124,CDM,320,RC,74300,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.23,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.23,175.13,
XR ORBITS,1510127,CDM,320,RC,70200,HCPCS,outpatient,,,102,51,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.7,35,,28.56,percent of total billed charges,35% of total billed charges for outpatient setting,79.56,78,,63.648,percent of total billed charges,78% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,84.66,83,,67.728,percent of total billed charges,83% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.95,39.17,,31.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.7,94.43,
XR OS-CALCIS LEFT,1510129,CDM,320,RC,73650,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.18,207.5,
XR PATELLA LEFT,1510133,CDM,320,RC,73564,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TISSUE BIOPSY,1510148,CDM,320,RC,76098,HCPCS,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,17.28,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.28,543.65,
XR RIBS PA CHEST 3 VIEW UNIL,1510149,CDM,320,RC,71101,HCPCS,outpatient,,,332.54,166.27,,232.78,70,,186.224,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,127.7,38.4,,102.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.7,38.4,,102.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,47.47,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.39,35,,93.112,percent of total billed charges,35% of total billed charges for outpatient setting,259.38,78,,207.504,percent of total billed charges,78% of total billed charges for outpatient setting,232.78,70,,186.224,percent of total billed charges,70% of total billed charges for outpatient setting,232.78,70,,186.224,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.41,75,,199.528,percent of total billed charges,75% of total billed charges for outpatient setting,276.01,83,,220.808,percent of total billed charges,83% of total billed charges for outpatient setting,166.27,50,,133.016,percent of total billed charges,50% of total billed charges for outpatient setting,166.27,50,,133.016,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,130.25,39.17,,104.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.47,276.01,
XR SACRO-ILIAC JOINT,1510150,CDM,320,RC,72202,HCPCS,outpatient,,,111,55.5,,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.62,38.4,,34.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.85,35,,31.08,percent of total billed charges,35% of total billed charges for outpatient setting,86.58,78,,69.264,percent of total billed charges,78% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,77.7,70,,62.16,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.25,75,,66.6,percent of total billed charges,75% of total billed charges for outpatient setting,92.13,83,,73.704,percent of total billed charges,83% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,55.5,50,,44.4,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.47,39.17,,34.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.85,94.43,
XR SACRUM & COCCYX,1510152,CDM,320,RC,72220,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.86,288.84,
XR SCAPULA LEFT,1510156,CDM,320,RC,73010,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,94.43,
XR SHOULDER INT-EXT LEFT,1510160,CDM,320,RC,73030,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.56,404.38,
XR SINUSES PARANASAL,1510164,CDM,320,RC,70220,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.17,288.84,
XR SKULL 4 VIEWS,1510168,CDM,320,RC,70260,HCPCS,outpatient,,,113,56.5,,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,54.34,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,35,,31.64,percent of total billed charges,35% of total billed charges for outpatient setting,88.14,78,,70.512,percent of total billed charges,78% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.79,83,,75.032,percent of total billed charges,83% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.26,39.17,,35.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,94.43,
RF SMALL-BOWEL SERIES,1510170,CDM,320,RC,74250,HCPCS,outpatient,,,601,300.5,,420.7,70,,336.56,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,230.78,38.4,,184.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.78,38.4,,184.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,154.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.35,35,,168.28,percent of total billed charges,35% of total billed charges for outpatient setting,468.78,78,,375.024,percent of total billed charges,78% of total billed charges for outpatient setting,420.7,70,,336.56,percent of total billed charges,70% of total billed charges for outpatient setting,420.7,70,,336.56,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,450.75,75,,360.6,percent of total billed charges,75% of total billed charges for outpatient setting,498.83,83,,399.064,percent of total billed charges,83% of total billed charges for outpatient setting,300.5,50,,240.4,percent of total billed charges,50% of total billed charges for outpatient setting,300.5,50,,240.4,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,235.4,39.17,,188.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.51,498.83,
XR STERNUM,1510172,CDM,320,RC,71120,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR STERNO-CLAVICULAR JT,1510174,CDM,320,RC,71130,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.17,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TEMPRO-MANDIBULAR JT BILATERAL,1510175,CDM,320,RC,70330,HCPCS,outpatient,,,166,83,,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,63.74,38.4,,50.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.74,38.4,,50.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,67.37,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.1,35,,46.48,percent of total billed charges,35% of total billed charges for outpatient setting,129.48,78,,103.584,percent of total billed charges,78% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.78,83,,110.224,percent of total billed charges,83% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.01,39.17,,52.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.1,137.78,
XR TIBIA & FIBULA AP-L LEFT,1510177,CDM,320,RC,73590,HCPCS,outpatient,,,109.2,54.6,,76.44,70,,61.152,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,41.93,38.4,,33.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.93,38.4,,33.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.22,35,,30.576,percent of total billed charges,35% of total billed charges for outpatient setting,85.18,78,,68.144,percent of total billed charges,78% of total billed charges for outpatient setting,76.44,70,,61.152,percent of total billed charges,70% of total billed charges for outpatient setting,76.44,70,,61.152,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,75,,65.52,percent of total billed charges,75% of total billed charges for outpatient setting,90.64,83,,72.512,percent of total billed charges,83% of total billed charges for outpatient setting,54.6,50,,43.68,percent of total billed charges,50% of total billed charges for outpatient setting,54.6,50,,43.68,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.77,39.17,,34.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.22,90.64,
XR TOE AP-OBL & LAT/LEFT FOOT GR,1510179,CDM,320,RC,73660,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR THORACIC SPINE,1510181,CDM,320,RC,72072,HCPCS,outpatient,,,772.8,386.4,,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.76,38.4,,237.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270.48,35,,216.384,percent of total billed charges,35% of total billed charges for outpatient setting,602.78,78,,482.224,percent of total billed charges,78% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,540.96,70,,432.768,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,579.6,75,,463.68,percent of total billed charges,75% of total billed charges for outpatient setting,641.42,83,,513.136,percent of total billed charges,83% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,386.4,50,,309.12,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,302.7,39.17,,242.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,641.42,
RF T-TUBE CHOLANGIOGRAM,1510187,CDM,320,RC,74320,HCPCS,outpatient,,,1520,760,,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,583.68,38.4,,466.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,583.68,38.4,,466.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1140,75,,912,percent of total billed charges,75% of total billed charges for outpatient setting,1140,75,,912,percent of total billed charges,75% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1140,75,,912,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,532,35,,425.6,percent of total billed charges,35% of total billed charges for outpatient setting,1185.6,78,,948.48,percent of total billed charges,78% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1140,75,,912,percent of total billed charges,75% of total billed charges for outpatient setting,1261.6,83,,1009.28,percent of total billed charges,83% of total billed charges for outpatient setting,760,50,,608,percent of total billed charges,50% of total billed charges for outpatient setting,760,50,,608,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,595.35,39.17,,476.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,532,1261.6,
RF HYSTEROSALPINGO ATT,1510189,CDM,320,RC,74740,HCPCS,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,107.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.84,543.65,
XR WRIST W OBLIQUES LEFT,1510191,CDM,320,RC,73110,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.9,404.38,
RF GI AIR EFF W/ CONTRAST,1510371,CDM,320,RC,74246,HCPCS,outpatient,,,914,457,,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350.98,38.4,,280.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,177.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,319.9,35,,255.92,percent of total billed charges,35% of total billed charges for outpatient setting,712.92,78,,570.336,percent of total billed charges,78% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,639.8,70,,511.84,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,685.5,75,,548.4,percent of total billed charges,75% of total billed charges for outpatient setting,758.62,83,,606.896,percent of total billed charges,83% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,457,50,,365.6,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,358,39.17,,286.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,758.62,
XR BARIUM ENEMA RING,1510372,CDM,621,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
XR SYRINGES,1510376,CDM,621,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
RF GI TUBE PLACEMENT,1510383,CDM,320,RC,74340,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,160.08,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.1,160.08,
XR IVP HYPER STUDY,1510384,CDM,320,RC,74400,HCPCS,outpatient,,,530,265,,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,164.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,35,,148.4,percent of total billed charges,35% of total billed charges for outpatient setting,413.4,78,,330.72,percent of total billed charges,78% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,397.5,75,,318,percent of total billed charges,75% of total billed charges for outpatient setting,439.9,83,,351.92,percent of total billed charges,83% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.59,39.17,,166.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,439.9,
RF RETROGRADE UROGRAPHY,1510385,CDM,320,RC,74420,HCPCS,outpatient,,,530,265,,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,870.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,35,,148.4,percent of total billed charges,35% of total billed charges for outpatient setting,413.4,78,,330.72,percent of total billed charges,78% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,397.5,75,,318,percent of total billed charges,75% of total billed charges for outpatient setting,439.9,83,,351.92,percent of total billed charges,83% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.59,39.17,,166.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,870.11,
XR APICAL LORDOTIC,1510405,CDM,320,RC,71010,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
RF MYELOGRAM C-SPINE,1510431,CDM,320,RC,72240,HCPCS,outpatient,,,1230,615,,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,101.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,430.5,35,,344.4,percent of total billed charges,35% of total billed charges for outpatient setting,959.4,78,,767.52,percent of total billed charges,78% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,922.5,75,,738,percent of total billed charges,75% of total billed charges for outpatient setting,1020.9,83,,816.72,percent of total billed charges,83% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,481.77,39.17,,385.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.68,1020.9,
RF MYELOGRAM THORACIC,1510432,CDM,320,RC,72255,HCPCS,outpatient,,,1230,615,,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,100.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,430.5,35,,344.4,percent of total billed charges,35% of total billed charges for outpatient setting,959.4,78,,767.52,percent of total billed charges,78% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,922.5,75,,738,percent of total billed charges,75% of total billed charges for outpatient setting,1020.9,83,,816.72,percent of total billed charges,83% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,481.77,39.17,,385.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.3,1020.9,
XR BIOPSY ABDOMINAL,1510435,CDM,361,RC,49180,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,2175,
XR BIOPSY LIVER,1510436,CDM,361,RC,47000,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,2175,
XR BIOPSY LUNG,1510437,CDM,361,RC,32405,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,780,50,,624,percent of total billed charges,50% of total billed charges for outpatient setting,780,50,,624,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,546,1294.8,
XR BIOPSY PANCREAS,1510438,CDM,361,RC,48102,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,2175,
XR BIOPSY PLEURA,1510439,CDM,361,RC,32400,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,2175,
XR BIOPSY RENAL,1510440,CDM,361,RC,50200,HCPCS,outpatient,,,1560,780,,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,599.04,38.4,,479.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,35,,436.8,percent of total billed charges,35% of total billed charges for outpatient setting,1216.8,78,,973.44,percent of total billed charges,78% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1092,70,,873.6,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1170,75,,936,percent of total billed charges,75% of total billed charges for outpatient setting,1294.8,83,,1035.84,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.02,39.17,,488.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546,2175,
XR BIOPSY THYROID,1510441,CDM,361,RC,60100,HCPCS,outpatient,,,846,423,,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,324.86,38.4,,259.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,35,,236.88,percent of total billed charges,35% of total billed charges for outpatient setting,659.88,78,,527.904,percent of total billed charges,78% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,592.2,70,,473.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,634.5,75,,507.6,percent of total billed charges,75% of total billed charges for outpatient setting,702.18,83,,561.744,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.36,39.17,,265.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.1,1452,
XR CHI BIA NEDLE,1510447,CDM,621,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
XR CHEST OBLIQUE,1510450,CDM,320,RC,71048,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR CHEST LAT DECUB,1510451,CDM,320,RC,71048,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,94.43,
XR BIOPSY CHEST,1510459,CDM,320,RC,77002,HCPCS,outpatient,,,224,112,,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.4,35,,62.72,percent of total billed charges,35% of total billed charges for outpatient setting,174.72,78,,139.776,percent of total billed charges,78% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,185.92,83,,148.736,percent of total billed charges,83% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.74,39.17,,70.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.4,185.92,
XR INJ THORACIC SPINE,1510467,CDM,360,RC,62284,HCPCS,outpatient,,,229,114.5,,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.94,38.4,,70.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.94,38.4,,70.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.15,35,,64.12,percent of total billed charges,35% of total billed charges for outpatient setting,178.62,78,,142.896,percent of total billed charges,78% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,190.07,83,,152.056,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.7,39.17,,71.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.15,659,
XR MULTI PAK,1510470,CDM,621,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
XR ELBOW 2 VIEWS LEFT,1510481,CDM,320,RC,73070,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.1,78.05,
XR RIBS UNILATERAL,1510485,CDM,320,RC,71100,HCPCS,outpatient,,,293.71,146.86,,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.78,38.4,,90.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,42.68,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.8,35,,82.24,percent of total billed charges,35% of total billed charges for outpatient setting,229.09,78,,183.272,percent of total billed charges,78% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,205.6,70,,164.48,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,220.28,75,,176.224,percent of total billed charges,75% of total billed charges for outpatient setting,243.78,83,,195.024,percent of total billed charges,83% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,146.86,50,,117.488,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.04,39.17,,92.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.68,243.78,
XR TMJ UNIL LT,1510486,CDM,320,RC,70328,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.3,98.77,
MM NEEDLE LOC BREAST LEFT,1510488,CDM,401,RC,19281,HCPCS,outpatient,,,299,149.5,,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.65,35,,83.72,percent of total billed charges,35% of total billed charges for outpatient setting,233.22,78,,186.576,percent of total billed charges,78% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,248.17,83,,198.536,percent of total billed charges,83% of total billed charges for outpatient setting,478.4,100,,,case rate,100% UHC case rate for outpatient setting,478.4,100,,,case rate,100% UHC case rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.12,39.17,,93.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.65,1392.65,
XR WRIST AP/LAT LEFT,1510490,CDM,320,RC,73100,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR HAND 2 VIEWS LEFT,1510491,CDM,320,RC,73120,HCPCS,outpatient,,,460,230,,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,176.64,38.4,,141.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,176.64,38.4,,141.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161,35,,128.8,percent of total billed charges,35% of total billed charges for outpatient setting,358.8,78,,287.04,percent of total billed charges,78% of total billed charges for outpatient setting,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,381.8,83,,305.44,percent of total billed charges,83% of total billed charges for outpatient setting,230,50,,184,percent of total billed charges,50% of total billed charges for outpatient setting,230,50,,184,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.17,39.17,,144.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.56,381.8,
XR KNEE COMP TUN/PAT LEFT,1510493,CDM,320,RC,73564,HCPCS,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.6,35,,26.88,percent of total billed charges,35% of total billed charges for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.6,39.17,,30.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.6,94.43,
XR ANKLE 3 VIEWS LEFT,1510494,CDM,320,RC,73610,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,404.38,
XR FOOT AP/LAT LEFT,1510495,CDM,320,RC,73620,HCPCS,outpatient,,,299,149.5,,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.82,38.4,,91.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.65,35,,83.72,percent of total billed charges,35% of total billed charges for outpatient setting,233.22,78,,186.576,percent of total billed charges,78% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,209.3,70,,167.44,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,224.25,75,,179.4,percent of total billed charges,75% of total billed charges for outpatient setting,248.17,83,,198.536,percent of total billed charges,83% of total billed charges for outpatient setting,149.5,50,,119.6,percent of total billed charges,50% of total billed charges for outpatient setting,149.5,50,,119.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.12,39.17,,93.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.81,248.17,
XR RIBS BIL/PA CHEST,1510567,CDM,320,RC,71111,HCPCS,outpatient,,,117,58.5,,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.93,38.4,,35.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.93,38.4,,35.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,59.15,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.95,35,,32.76,percent of total billed charges,35% of total billed charges for outpatient setting,91.26,78,,73.008,percent of total billed charges,78% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,97.11,83,,77.688,percent of total billed charges,83% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.83,39.17,,36.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.95,97.11,
XR MANDIBLE LESS 4 VIEW,1510568,CDM,320,RC,70100,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28,78.05,
RF SPINE PUNCTURE LUMBA,1510575,CDM,361,RC,62270,HCPCS,outpatient,,,729,364.5,,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.94,38.4,,223.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,255.15,35,,204.12,percent of total billed charges,35% of total billed charges for outpatient setting,568.62,78,,454.896,percent of total billed charges,78% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,510.3,70,,408.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,546.75,75,,437.4,percent of total billed charges,75% of total billed charges for outpatient setting,605.07,83,,484.056,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.54,39.17,,228.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,255.15,1452,
NM STRESS EKG,1510584,CDM,482,RC,93017,HCPCS,outpatient,,,890.42,445.21,,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,341.92,38.4,,273.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,341.92,38.4,,273.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,667.82,75,,534.256,percent of total billed charges,75% of total billed charges for outpatient setting,667.82,75,,534.256,percent of total billed charges,75% of total billed charges for outpatient setting,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,667.82,75,,534.256,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,311.65,35,,249.32,percent of total billed charges,35% of total billed charges for outpatient setting,694.53,78,,555.624,percent of total billed charges,78% of total billed charges for outpatient setting,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,623.29,70,,498.632,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,667.82,75,,534.256,percent of total billed charges,75% of total billed charges for outpatient setting,739.05,83,,591.24,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,348.76,39.17,,279.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,739.05,
RF FLUORO OVER 1 HR,1510589,CDM,320,RC,76001,HCPCS,outpatient,,,168,84,,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.51,38.4,,51.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.51,38.4,,51.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,218.25,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.8,35,,47.04,percent of total billed charges,35% of total billed charges for outpatient setting,131.04,78,,104.832,percent of total billed charges,78% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,117.6,70,,94.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126,75,,100.8,percent of total billed charges,75% of total billed charges for outpatient setting,139.44,83,,111.552,percent of total billed charges,83% of total billed charges for outpatient setting,84,50,,67.2,percent of total billed charges,50% of total billed charges for outpatient setting,84,50,,67.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.8,39.17,,52.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.8,218.25,
RF ARTHROGRAM LEFT SHOULDER,1510592,CDM,322,RC,73040,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.85,580.17,
XR ANKLE 3 VIEWS RIGHT,1510608,CDM,320,RC,73610,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,404.38,
RF ARTHROGRAM RIGHT SHOULDER,1510609,CDM,322,RC,73040,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,142.85,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.85,580.17,
XR CLAVICLE RIGHT,1510610,CDM,320,RC,73000,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.86,288.84,
XR ELBOW 3 VIEWS RIGHT,1510617,CDM,320,RC,73080,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,404.38,
XR FEMUR RIGHT,1510618,CDM,320,RC,73552,HCPCS,outpatient,,,350,175,,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,45.41,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.5,35,,98,percent of total billed charges,35% of total billed charges for outpatient setting,273,78,,218.4,percent of total billed charges,78% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,290.5,83,,232.4,percent of total billed charges,83% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.09,39.17,,109.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.41,290.5,
XR FOOT RIGHT,1510619,CDM,320,RC,73630,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,40.62,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.62,404.38,
XR FOREARM RIGHT,1510620,CDM,320,RC,73090,HCPCS,outpatient,,,117.6,58.8,,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.16,38.4,,36.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.16,38.4,,36.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.16,35,,32.928,percent of total billed charges,35% of total billed charges for outpatient setting,91.73,78,,73.384,percent of total billed charges,78% of total billed charges for outpatient setting,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.2,75,,70.56,percent of total billed charges,75% of total billed charges for outpatient setting,97.61,83,,78.088,percent of total billed charges,83% of total billed charges for outpatient setting,58.8,50,,47.04,percent of total billed charges,50% of total billed charges for outpatient setting,58.8,50,,47.04,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.06,39.17,,36.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,97.61,
XR HAND RIGHT,1510621,CDM,320,RC,73130,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.73,404.38,
XR HIP AP UNILATERAL RIGHT,1510622,CDM,320,RC,73502,HCPCS,outpatient,,,274.3,137.15,,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,105.33,38.4,,84.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.33,38.4,,84.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,58.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.01,35,,76.808,percent of total billed charges,35% of total billed charges for outpatient setting,213.95,78,,171.16,percent of total billed charges,78% of total billed charges for outpatient setting,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,192.01,70,,153.608,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.73,75,,164.584,percent of total billed charges,75% of total billed charges for outpatient setting,227.67,83,,182.136,percent of total billed charges,83% of total billed charges for outpatient setting,137.15,50,,109.72,percent of total billed charges,50% of total billed charges for outpatient setting,137.15,50,,109.72,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.44,39.17,,85.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.45,227.67,
XR HUMERUS RIGHT,1510623,CDM,320,RC,73060,HCPCS,outpatient,,,76.45,38.23,,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.36,38.4,,23.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.36,38.4,,23.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.92,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.76,35,,21.408,percent of total billed charges,35% of total billed charges for outpatient setting,59.63,78,,47.704,percent of total billed charges,78% of total billed charges for outpatient setting,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,53.52,70,,42.816,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.34,75,,45.872,percent of total billed charges,75% of total billed charges for outpatient setting,63.45,83,,50.76,percent of total billed charges,83% of total billed charges for outpatient setting,38.23,50,,30.584,percent of total billed charges,50% of total billed charges for outpatient setting,38.23,50,,30.584,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.95,39.17,,23.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.76,78.05,
XR KNEE COMP TUN/PAT RIGHT,1510624,CDM,320,RC,73564,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.01,207.5,
XR KNEE 3 VIEWS RIGHT,1510625,CDM,320,RC,73562,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.9,404.38,
XR FINGER/LEFT HAND 2ND DIGIT,1510626,CDM,320,RC,73140,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR FINGER/LEFT HAND 3RD DIGIT,1510627,CDM,320,RC,73140,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR FINGER/LEFT HAND 4TH DIGIT,1510628,CDM,320,RC,73140,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,288.84,
XR FINGER/LEFT HAND 5TH DIGIT,1510629,CDM,320,RC,73140,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,207.5,
XR FINGER/RIGHT HAND THUMB,1510630,CDM,320,RC,73140,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,207.5,
XR FINGER/RIGHT HAND 2ND DIGIT,1510631,CDM,320,RC,73140,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,288.84,
XR FINGER/RIGHT HAND 3RD DIGIT,1510632,CDM,320,RC,73140,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,207.5,
XR FINGER/RIGHT HAND 4TH DIGIT,1510633,CDM,320,RC,73140,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,288.84,
XR FINGER/RIGHT HAND 5TH DIGIT,1510634,CDM,320,RC,73140,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,48.84,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.84,207.5,
MM NEEDLE LOC BREAST RIGHT,1510635,CDM,401,RC,19281,HCPCS,outpatient,,,264,132,,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,101.38,38.4,,81.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.38,38.4,,81.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.4,35,,73.92,percent of total billed charges,35% of total billed charges for outpatient setting,205.92,78,,164.736,percent of total billed charges,78% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,219.12,83,,175.296,percent of total billed charges,83% of total billed charges for outpatient setting,422.4,100,,,case rate,100% UHC case rate for outpatient setting,422.4,100,,,case rate,100% UHC case rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.41,39.17,,82.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.4,1392.65,
XR PATELLA RIGHT,1510636,CDM,320,RC,73564,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.01,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR OS-CALCIS RIGHT,1510637,CDM,320,RC,73650,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.18,288.84,
XR SCAPULA RIGHT,1510638,CDM,320,RC,73010,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,94.43,
XR SHOULDER INT-EXT RIGHT,1510639,CDM,320,RC,73030,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.56,404.38,
XR TIBIA & FIBULA AP-L RIGHT,1510640,CDM,320,RC,73590,HCPCS,outpatient,,,117.6,58.8,,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.16,38.4,,36.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.16,38.4,,36.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,39.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.16,35,,32.928,percent of total billed charges,35% of total billed charges for outpatient setting,91.73,78,,73.384,percent of total billed charges,78% of total billed charges for outpatient setting,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,82.32,70,,65.856,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.2,75,,70.56,percent of total billed charges,75% of total billed charges for outpatient setting,97.61,83,,78.088,percent of total billed charges,83% of total billed charges for outpatient setting,58.8,50,,47.04,percent of total billed charges,50% of total billed charges for outpatient setting,58.8,50,,47.04,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.06,39.17,,36.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.24,97.61,
XR WRIST AP/LAT RIGHT,1510641,CDM,320,RC,73100,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,78.05,
RF WRIST ARTHOGRAM RIGHT,1510642,CDM,322,RC,73115,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.77,580.17,
XR WRIST W OBLIQUES RIGHT,1510643,CDM,320,RC,73110,HCPCS,outpatient,,,487.2,243.6,,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.08,38.4,,149.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,50.9,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.52,35,,136.416,percent of total billed charges,35% of total billed charges for outpatient setting,380.02,78,,304.016,percent of total billed charges,78% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,341.04,70,,272.832,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.4,75,,292.32,percent of total billed charges,75% of total billed charges for outpatient setting,404.38,83,,323.504,percent of total billed charges,83% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,243.6,50,,194.88,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.82,39.17,,152.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.9,404.38,
XR TOE AP-OBL & LAT/LEFT FOOT 2N,1510645,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/LEFT FOOT 3R,1510646,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/LEFT FOOT 4T,1510647,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/LEFT FOOT 5T,1510648,CDM,320,RC,73660,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.98,207.5,
XR TOE AP-OBL & LAT/RIGHT FOOT G,1510649,CDM,320,RC,73660,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.98,207.5,
XR TOE AP-OBL & LAT/RIGHT FOOT 2,1510650,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/RIGHT FOOT 3,1510651,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/RIGHT FOOT 4,1510652,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR TOE AP-OBL & LAT/RIGHT FOOT 5,1510653,CDM,320,RC,73660,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR PELVIS/HIPS CHILD,1517733,CDM,320,RC,73540,HCPCS,outpatient,,,142,71,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.7,35,,39.76,percent of total billed charges,35% of total billed charges for outpatient setting,110.76,78,,88.608,percent of total billed charges,78% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.86,83,,94.288,percent of total billed charges,83% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.62,39.17,,44.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49.7,117.86,
XR ANKLE AP LAT RIGHT,1517734,CDM,320,RC,73600,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.3,207.5,
XR ELBOW 2 VIEWS RIGHT,1517735,CDM,320,RC,73070,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,78.05,
XR FOOT AP/LAT RIGHT,1517736,CDM,320,RC,73620,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,35.81,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.81,288.84,
XR HAND 2 VIEWS RIGHT,1517737,CDM,320,RC,73120,HCPCS,outpatient,,,460,230,,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,176.64,38.4,,141.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,176.64,38.4,,141.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,38.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161,35,,128.8,percent of total billed charges,35% of total billed charges for outpatient setting,358.8,78,,287.04,percent of total billed charges,78% of total billed charges for outpatient setting,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,322,70,,257.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,381.8,83,,305.44,percent of total billed charges,83% of total billed charges for outpatient setting,230,50,,184,percent of total billed charges,50% of total billed charges for outpatient setting,230,50,,184,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180.17,39.17,,144.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.56,381.8,
XR KNEE 2 VIEWS RIGHT,1517738,CDM,320,RC,73560,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,175.13,
XR CYSTOCONRAY,1517739,CDM,320,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
RF C-ARM EXAM,1519988,CDM,320,RC,76000,HCPCS,outpatient,,,947,473.5,,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,363.65,38.4,,290.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,363.65,38.4,,290.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.45,35,,265.16,percent of total billed charges,35% of total billed charges for outpatient setting,738.66,78,,590.928,percent of total billed charges,78% of total billed charges for outpatient setting,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,662.9,70,,530.32,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,710.25,75,,568.2,percent of total billed charges,75% of total billed charges for outpatient setting,786.01,83,,628.808,percent of total billed charges,83% of total billed charges for outpatient setting,473.5,50,,378.8,percent of total billed charges,50% of total billed charges for outpatient setting,473.5,50,,378.8,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.92,39.17,,296.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,786.01,
XR SPINE SINGLE VIEW,1519990,CDM,320,RC,72020,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,28.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.26,98.77,
XR INFANT BONE SURVEY,1519992,CDM,320,RC,77076,HCPCS,outpatient,,,234,117,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,35,,65.52,percent of total billed charges,35% of total billed charges for outpatient setting,182.52,78,,146.016,percent of total billed charges,78% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.22,83,,155.376,percent of total billed charges,83% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.66,39.17,,73.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,194.22,
XR INFANT OSSEOUS SURVEY,1519993,CDM,320,RC,77076,HCPCS,outpatient,,,234,117,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,117.45,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,35,,65.52,percent of total billed charges,35% of total billed charges for outpatient setting,182.52,78,,146.016,percent of total billed charges,78% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.22,83,,155.376,percent of total billed charges,83% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.66,39.17,,73.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,194.22,
RF DRAINAGE TUBE PLACEMENT,1519994,CDM,320,RC,75989,HCPCS,outpatient,,,296,148,,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.66,38.4,,90.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.66,38.4,,90.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,400,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.6,35,,82.88,percent of total billed charges,35% of total billed charges for outpatient setting,230.88,78,,184.704,percent of total billed charges,78% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,207.2,70,,165.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,222,75,,177.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.68,83,,196.544,percent of total billed charges,83% of total billed charges for outpatient setting,148,50,,118.4,percent of total billed charges,50% of total billed charges for outpatient setting,148,50,,118.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.93,39.17,,92.744,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,103.6,400,
XR INFANT LOWER EXT,1519995,CDM,320,RC,73592,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.18,98.77,
XR INFANT UPPER EXT,1519996,CDM,320,RC,73092,HCPCS,outpatient,,,263,131.5,,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,100.99,38.4,,80.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.99,38.4,,80.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.05,35,,73.64,percent of total billed charges,35% of total billed charges for outpatient setting,205.14,78,,164.112,percent of total billed charges,78% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.25,75,,157.8,percent of total billed charges,75% of total billed charges for outpatient setting,218.29,83,,174.632,percent of total billed charges,83% of total billed charges for outpatient setting,131.5,50,,105.2,percent of total billed charges,50% of total billed charges for outpatient setting,131.5,50,,105.2,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.01,39.17,,82.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.18,218.29,
XR TOMOGRAMS,1530007,CDM,320,RC,76100,HCPCS,outpatient,,,215,107.5,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,116.09,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.25,35,,60.2,percent of total billed charges,35% of total billed charges for outpatient setting,167.7,78,,134.16,percent of total billed charges,78% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,178.45,83,,142.76,percent of total billed charges,83% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.21,39.17,,67.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.25,178.45,
XR FOREIGN BODY LOC,1530015,CDM,320,RC,76010,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,33.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.07,98.77,
XR PELVIS,1530041,CDM,320,RC,72170,HCPCS,outpatient,,,107.8,53.9,,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,41.4,38.4,,33.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.4,38.4,,33.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.73,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.73,35,,30.184,percent of total billed charges,35% of total billed charges for outpatient setting,84.08,78,,67.264,percent of total billed charges,78% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,75,,64.68,percent of total billed charges,75% of total billed charges for outpatient setting,89.47,83,,71.576,percent of total billed charges,83% of total billed charges for outpatient setting,53.9,50,,43.12,percent of total billed charges,50% of total billed charges for outpatient setting,53.9,50,,43.12,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.23,39.17,,33.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.73,94.43,
RF PHLEBOGRAM BILATERAL,1530048,CDM,320,RC,75822,HCPCS,outpatient,,,1520,760,,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,583.68,38.4,,466.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,583.68,38.4,,466.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,162.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,532,35,,425.6,percent of total billed charges,35% of total billed charges for outpatient setting,1185.6,78,,948.48,percent of total billed charges,78% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1064,70,,851.2,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1140,75,,912,percent of total billed charges,75% of total billed charges for outpatient setting,1261.6,83,,1009.28,percent of total billed charges,83% of total billed charges for outpatient setting,760,50,,608,percent of total billed charges,50% of total billed charges for outpatient setting,760,50,,608,percent of total billed charges,50% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,595.35,39.17,,476.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162.05,1375.68,
XR PHLEBOGRAM UNILATERAL,1530050,CDM,320,RC,75820,HCPCS,outpatient,,,1702,851,,1191.4,70,,953.12,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,653.57,38.4,,522.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,653.57,38.4,,522.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,156.56,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,595.7,35,,476.56,percent of total billed charges,35% of total billed charges for outpatient setting,1327.56,78,,1062.048,percent of total billed charges,78% of total billed charges for outpatient setting,1191.4,70,,953.12,percent of total billed charges,70% of total billed charges for outpatient setting,1191.4,70,,953.12,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1276.5,75,,1021.2,percent of total billed charges,75% of total billed charges for outpatient setting,1412.66,83,,1130.128,percent of total billed charges,83% of total billed charges for outpatient setting,851,50,,680.8,percent of total billed charges,50% of total billed charges for outpatient setting,851,50,,680.8,percent of total billed charges,50% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,666.64,39.17,,533.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.56,1412.66,
RF NEPHROTOMOGRAPHY,1530052,CDM,320,RC,74415,HCPCS,outpatient,,,530,265,,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,216.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,35,,148.4,percent of total billed charges,35% of total billed charges for outpatient setting,413.4,78,,330.72,percent of total billed charges,78% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,397.5,75,,318,percent of total billed charges,75% of total billed charges for outpatient setting,439.9,83,,351.92,percent of total billed charges,83% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.59,39.17,,166.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,439.9,
RF GI SERIES,1530062,CDM,320,RC,74240,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,157.82,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,98.7,234.06,
RF URETHROCYSTOGRAPHY RETROGRADE,1530068,CDM,320,RC,74450,HCPCS,outpatient,,,530,265,,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203.52,38.4,,162.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,467.38,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,35,,148.4,percent of total billed charges,35% of total billed charges for outpatient setting,413.4,78,,330.72,percent of total billed charges,78% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,371,70,,296.8,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,397.5,75,,318,percent of total billed charges,75% of total billed charges for outpatient setting,439.9,83,,351.92,percent of total billed charges,83% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,265,50,,212,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,207.59,39.17,,166.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,185.5,467.38,
XR SKULL LIMITED STUDY,1530131,CDM,320,RC,70250,HCPCS,outpatient,,,220,110,,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.48,38.4,,67.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.11,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77,35,,61.6,percent of total billed charges,35% of total billed charges for outpatient setting,171.6,78,,137.28,percent of total billed charges,78% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,182.6,83,,146.08,percent of total billed charges,83% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,110,50,,88,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.17,39.17,,68.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.11,182.6,
XR KNEE 2 VIEWS LEFT,1530132,CDM,320,RC,73560,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.05,207.5,
XR U/S CALL BACK,1530200,CDM,621,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
XR GASTROGRAFIN,1530370,CDM,636,RC,Q9967,HCPCS,both,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,0.83,
XR CHEST INDUSTRIAL,1550000,CDM,320,RC,71010,HCPCS,outpatient,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.95,35,,21.56,percent of total billed charges,35% of total billed charges for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.16,39.17,,24.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.95,63.91,
XR E-Z PAQUE,1552950,CDM,255,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
XR POLIBAR 8 OZ,1554660,CDM,255,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
XR EZ CAT 8OZ,1554661,CDM,255,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
CONTRAST OPTIRAY 300,1556910,CDM,636,RC,Q9967,HCPCS,both,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
XR E-Z GAS II,1567026,CDM,255,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
RF MYLOGRAM LUMBAR,1570045,CDM,320,RC,72265,HCPCS,outpatient,,,1230,615,,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,472.32,38.4,,377.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,98.24,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,430.5,35,,344.4,percent of total billed charges,35% of total billed charges for outpatient setting,959.4,78,,767.52,percent of total billed charges,78% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,861,70,,688.8,percent of total billed charges,70% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,922.5,75,,738,percent of total billed charges,75% of total billed charges for outpatient setting,1020.9,83,,816.72,percent of total billed charges,83% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,615,50,,492,percent of total billed charges,50% of total billed charges for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,481.77,39.17,,385.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,687.76,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,98.24,1020.9,
DX DUAL BONE DENSITY ST,1580009,CDM,320,RC,77080,HCPCS,outpatient,,,394.99,197.5,,276.49,70,,221.192,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,151.68,38.4,,121.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.68,38.4,,121.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,61.88,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.25,35,,110.6,percent of total billed charges,35% of total billed charges for outpatient setting,308.09,78,,246.472,percent of total billed charges,78% of total billed charges for outpatient setting,276.49,70,,221.192,percent of total billed charges,70% of total billed charges for outpatient setting,276.49,70,,221.192,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.24,75,,236.992,percent of total billed charges,75% of total billed charges for outpatient setting,327.84,83,,262.272,percent of total billed charges,83% of total billed charges for outpatient setting,197.5,50,,158,percent of total billed charges,50% of total billed charges for outpatient setting,197.5,50,,158,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.71,39.17,,123.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.88,327.84,
XR HS IND PHYSICAL,1580010,CDM,320,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
RF WRIST ARTHOGRAM LEFT,1580012,CDM,322,RC,73115,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,151.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,151.77,580.17,
RF PHARYNX/LARYNX EXAM,1580024,CDM,320,RC,70370,HCPCS,outpatient,,,323,161.5,,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,108.54,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.05,35,,90.44,percent of total billed charges,35% of total billed charges for outpatient setting,251.94,78,,201.552,percent of total billed charges,78% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.09,83,,214.472,percent of total billed charges,83% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.51,39.17,,101.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,268.09,
RF COMPLETE DYNAMIC PHARYNGEAL &,1580025,CDM,320,RC,70371,HCPCS,outpatient,,,323,161.5,,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.03,38.4,,99.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,91.39,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.05,35,,90.44,percent of total billed charges,35% of total billed charges for outpatient setting,251.94,78,,201.552,percent of total billed charges,78% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,226.1,70,,180.88,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,242.25,75,,193.8,percent of total billed charges,75% of total billed charges for outpatient setting,268.09,83,,214.472,percent of total billed charges,83% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,161.5,50,,129.2,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.51,39.17,,101.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.39,268.09,
XR CLINICAL EVALUATION OF SWALLOW,1580026,CDM,320,RC,92610,HCPCS,outpatient,,,179,89.5,,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,68.74,38.4,,54.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.74,38.4,,54.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.65,35,,50.12,percent of total billed charges,35% of total billed charges for outpatient setting,139.62,78,,111.696,percent of total billed charges,78% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,125.3,70,,100.24,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.25,75,,107.4,percent of total billed charges,75% of total billed charges for outpatient setting,148.57,83,,118.856,percent of total billed charges,83% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,89.5,50,,71.6,percent of total billed charges,50% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.11,39.17,,56.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.65,148.57,
XR SACROILIAC JOINTS EXAM LESS TH,1580032,CDM,320,RC,72200,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.86,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.86,98.77,
NM SINCALIDE,1580038,CDM,636,RC,J2805,HCPCS,both,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
RF KNEE ARTHROGRAM LEFT,1588893,CDM,322,RC,73580,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.98,580.17,
XR KNEE ARTHROGRAM INJ,1588894,CDM,360,RC,27370,HCPCS,outpatient,,,432,216,,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.89,38.4,,132.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.2,35,,120.96,percent of total billed charges,35% of total billed charges for outpatient setting,336.96,78,,269.568,percent of total billed charges,78% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,302.4,70,,241.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,324,75,,259.2,percent of total billed charges,75% of total billed charges for outpatient setting,358.56,83,,286.848,percent of total billed charges,83% of total billed charges for outpatient setting,216,50,,172.8,percent of total billed charges,50% of total billed charges for outpatient setting,216,50,,172.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.21,39.17,,135.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,151.2,358.56,
RF HIP ARTHROGRAM LEFT,1588898,CDM,322,RC,73525,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.52,580.17,
RF HIP ARTHROGRAM RIGHT,1588900,CDM,322,RC,73525,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,143.52,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.52,580.17,
RF KNEE ARTHROGRAM RIGHT,1588901,CDM,322,RC,73580,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.42,38.4,,214.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,170.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,244.65,35,,195.72,percent of total billed charges,35% of total billed charges for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,273.79,39.17,,219.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,330.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.98,580.17,
XR TMJ UNIL RT,1588902,CDM,320,RC,70328,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.3,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.3,98.77,
XR SCOLIOSIS STUDY,1588903,CDM,320,RC,72090,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,41.65,98.77,
US GUIDANCE FOR PERICA,1588908,CDM,402,RC,76930,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,110.83,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,164.8,100,,,case rate,100% UHC case rate for outpatient setting,164.8,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,164.8,
XR AP/LAT/FLEX/EXT L-SPINE,1588910,CDM,320,RC,72120,HCPCS,outpatient,,,394,197,,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.3,38.4,,121.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,57.07,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.9,35,,110.32,percent of total billed charges,35% of total billed charges for outpatient setting,307.32,78,,245.856,percent of total billed charges,78% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,275.8,70,,220.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,295.5,75,,236.4,percent of total billed charges,75% of total billed charges for outpatient setting,327.02,83,,261.616,percent of total billed charges,83% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,197,50,,157.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,154.33,39.17,,123.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.07,327.02,
XR BONE AGE STUDY,1588911,CDM,320,RC,77072,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,26.2,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21,94.43,
XR COMPLETE L-SPINE W/FLEX & EXT,1588912,CDM,320,RC,72114,HCPCS,outpatient,,,552,276,,386.4,70,,309.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,211.97,38.4,,169.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.97,38.4,,169.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,87.26,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,193.2,35,,154.56,percent of total billed charges,35% of total billed charges for outpatient setting,430.56,78,,344.448,percent of total billed charges,78% of total billed charges for outpatient setting,386.4,70,,309.12,percent of total billed charges,70% of total billed charges for outpatient setting,386.4,70,,309.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414,75,,331.2,percent of total billed charges,75% of total billed charges for outpatient setting,458.16,83,,366.528,percent of total billed charges,83% of total billed charges for outpatient setting,276,50,,220.8,percent of total billed charges,50% of total billed charges for outpatient setting,276,50,,220.8,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216.21,39.17,,172.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.26,458.16,
XR BONE LENGTH STUDY,1588914,CDM,320,RC,77073,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,41.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
XR SCOLIOSIS SERIES,1588915,CDM,320,RC,72084,HCPCS,outpatient,,,765.8,382.9,,536.06,70,,428.848,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,294.07,38.4,,235.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.07,38.4,,235.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,127.75,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.03,35,,214.424,percent of total billed charges,35% of total billed charges for outpatient setting,597.32,78,,477.856,percent of total billed charges,78% of total billed charges for outpatient setting,536.06,70,,428.848,percent of total billed charges,70% of total billed charges for outpatient setting,536.06,70,,428.848,percent of total billed charges,70% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,574.35,75,,459.48,percent of total billed charges,75% of total billed charges for outpatient setting,635.61,83,,508.488,percent of total billed charges,83% of total billed charges for outpatient setting,382.9,50,,306.32,percent of total billed charges,50% of total billed charges for outpatient setting,382.9,50,,306.32,percent of total billed charges,50% of total billed charges for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,299.95,39.17,,239.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.43,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.43,635.61,
DX LVA,1588917,CDM,320,RC,77086,HCPCS,outpatient,,,119,59.5,,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.7,38.4,,36.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,53.66,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,35,,33.32,percent of total billed charges,35% of total billed charges for outpatient setting,92.82,78,,74.256,percent of total billed charges,78% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,83.3,70,,66.64,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.25,75,,71.4,percent of total billed charges,75% of total billed charges for outpatient setting,98.77,83,,79.016,percent of total billed charges,83% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,59.5,50,,47.6,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.61,39.17,,37.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.65,98.77,
RF FLUORO UNDER 1 HOUR,1588923,CDM,320,RC,76000,HCPCS,outpatient,,,1226.4,613.2,,858.48,70,,686.784,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,470.94,38.4,,376.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,470.94,38.4,,376.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,75.6,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,429.24,35,,343.392,percent of total billed charges,35% of total billed charges for outpatient setting,956.59,78,,765.272,percent of total billed charges,78% of total billed charges for outpatient setting,858.48,70,,686.784,percent of total billed charges,70% of total billed charges for outpatient setting,858.48,70,,686.784,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,919.8,75,,735.84,percent of total billed charges,75% of total billed charges for outpatient setting,1017.91,83,,814.328,percent of total billed charges,83% of total billed charges for outpatient setting,613.2,50,,490.56,percent of total billed charges,50% of total billed charges for outpatient setting,613.2,50,,490.56,percent of total billed charges,50% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,480.36,39.17,,384.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,1017.91,
RF FISTULAGRAM,1588930,CDM,320,RC,76080,HCPCS,outpatient,,,655,327.5,,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,251.52,38.4,,201.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,55.71,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.25,35,,183.4,percent of total billed charges,35% of total billed charges for outpatient setting,510.9,78,,408.72,percent of total billed charges,78% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,458.5,70,,366.8,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,491.25,75,,393,percent of total billed charges,75% of total billed charges for outpatient setting,543.65,83,,434.92,percent of total billed charges,83% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,327.5,50,,262,percent of total billed charges,50% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.55,39.17,,205.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.71,543.65,
SODIUM CHLORIDE 0.45% 1000ML,1600035,CDM,250,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
QUINAPRIL (ACCUPRIL) 40 MG TABLET,1600057,CDM,637,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
ACETYLCYSTEINE (MUCOMYST) 20% ORAL,1600092,CDM,250,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
ACETAMINOPHEN (TYLENOL) 500 MG TABLET,1600254,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETAMINOPHEN (TYLENOL) 160 MG DOSE,1600318,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
APAP 120MG/COD 12MG  (TYLENOL W/COD) ELX,1600320,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
APAP (TYLENOL #3) 300MG/COD 30MG TAB,1600321,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACTIVATED CHARCOAL AQUEOUS 25GR/120ML,1600407,CDM,637,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
NIFEDIPINE ER (PROCARDIA XL) 30 MG TAB,1600425,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NIFEDIPINE ER (PROCARDIA XL) 60 MG TAB,1600426,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ADENOSINE (ADENOCARD) 6MG/2ML,1600436,CDM,636,RC,J0153,HCPCS,both,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,7.47,
EPINEPHRINE (ADRENALIN) 1MG/ML AMP,1600456,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
EPINEPHRINE 30MG/30ML,1600457,CDM,250,RC,,,outpatient,,,673,336.5,,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.43,38.4,,206.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,258.43,38.4,,206.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,504.75,75,,403.8,percent of total billed charges,75% of total billed charges for outpatient setting,504.75,75,,403.8,percent of total billed charges,75% of total billed charges for outpatient setting,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,504.75,75,,403.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.55,35,,188.44,percent of total billed charges,35% of total billed charges for outpatient setting,524.94,78,,419.952,percent of total billed charges,78% of total billed charges for outpatient setting,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,471.1,70,,376.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,504.75,75,,403.8,percent of total billed charges,75% of total billed charges for outpatient setting,558.59,83,,446.872,percent of total billed charges,83% of total billed charges for outpatient setting,336.5,50,,269.2,percent of total billed charges,50% of total billed charges for outpatient setting,336.5,50,,269.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.6,39.17,,210.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,235.55,558.59,
ALBUTEROL SULFATE (PROVENTIL) 2.5MG/3ML,1600651,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ALLOPURINOL (ZYLOPRIM) 100 MG TABLET,1600781,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ALLOPURINOL (ZYLOPRIM) 300 MG TABLET,1600833,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ALPRAZOLAM (XANAX) 0.25 MG TABLET,1600959,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ALPRAZOLAM (XANAX) 0.5 MG TABLET,1600960,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ZOLPIDEM (AMBIEN) 5 MG TABLET,1601057,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METHYLPREDNISOLONE(SOLU-MEDROL) 40MG/1ml,1601076,CDM,250,RC,,,outpatient,,,15.19,7.6,,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.32,35,,4.256,percent of total billed charges,35% of total billed charges for outpatient setting,11.85,78,,9.48,percent of total billed charges,78% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,12.61,83,,10.088,percent of total billed charges,83% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,39.17,,4.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.32,12.61,
ETOMIDATE (AMIDATE) 40MG/20ML VIAL,1601084,CDM,250,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
AMITRIPTYLINE (ELAVIL) 25 MG TABLET,1601436,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMMONIA AROMATIC AMP 0.33ML,1601443,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMOXICILLIN (AMOXIL) 500 MG capsule,1601606,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IRBESARTAN (AVAPRO) 150 MG TABLET,1601707,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMPICILLIN 1 GRAM vial,1601709,CDM,636,RC,J0290,HCPCS,both,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.06,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,18.26,
CEFEPIME (MAXIPIME) 2 Grams vial,1601710,CDM,250,RC,J0692,HCPCS,outpatient,,,51.8,25.9,,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.89,38.4,,15.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.89,38.4,,15.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.13,35,,14.504,percent of total billed charges,35% of total billed charges for outpatient setting,40.4,78,,32.32,percent of total billed charges,78% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,42.99,83,,34.392,percent of total billed charges,83% of total billed charges for outpatient setting,25.9,50,,20.72,percent of total billed charges,50% of total billed charges for outpatient setting,25.9,50,,20.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.29,39.17,,16.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.13,42.99,
AMPICILLIN 2 GRAM vial,1601739,CDM,636,RC,J0290,HCPCS,both,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.01,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.06,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.01,11.62,
AMPICILLIN 500 MG capsule,1601820,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
Calcium Carbonate (TUMS) 500 MG TAB,1601892,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHYSOSTIGMINE (ANTILIRIUM) 1MG/ML VIAL,1601953,CDM,250,RC,,,outpatient,,,145,72.5,,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55.68,38.4,,44.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.75,35,,40.6,percent of total billed charges,35% of total billed charges for outpatient setting,113.1,78,,90.48,percent of total billed charges,78% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,101.5,70,,81.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.75,75,,87,percent of total billed charges,75% of total billed charges for outpatient setting,120.35,83,,96.28,percent of total billed charges,83% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,72.5,50,,58,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.79,39.17,,45.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,50.75,120.35,
PROCTOSOL-HC (ANUSOL-HC) 2.5% CREAM,1601981,CDM,637,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
ARTIFICIAL TEARS drops,1602229,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
ASPIRIN 300 MG SUPPOSITORY,1602250,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ASPIRIN (COATED) 325 MG TABLET,1602319,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ASPIRIN ENTERIC COATED 81 MG TABLET,1602320,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ASPRIN (CHEWABLE) 81 MG TABLET,1602321,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ATENOLOL (TENORMIN) 50 MG TABLET,1602588,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LORAZEPAM (ATIVAN) 2 MG INJECTION,1602614,CDM,636,RC,J2060,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ATROPINE 8MG/20ML vial,1602630,CDM,250,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
ATROPINE 1% OPHTHALMIC 5ML,1602651,CDM,637,RC,,,outpatient,,,164,82,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.4,35,,45.92,percent of total billed charges,35% of total billed charges for outpatient setting,127.92,78,,102.336,percent of total billed charges,78% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,136.12,83,,108.896,percent of total billed charges,83% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.24,39.17,,51.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.4,136.12,
ATROPINE 0.4 MG/1ML VIAL,1602671,CDM,250,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
ATROPINE 1MG/10ML SYRINGE,1602674,CDM,250,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
AMOXICILLIN/CLAV(AUGMENTIN) 500 MG TAB,1602694,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AZTREONAM (AZACTAM) 1 GRAM vial,1602721,CDM,250,RC,,,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,35,,26.88,percent of total billed charges,35% of total billed charges for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.6,39.17,,30.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.6,79.68,
BACITRACIN 500U/GM OINT 28GM,1602793,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
BACLOFEN (LIORESAL) 10 MG TABLET,1602876,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NEOMY/BACIT/POLYMYX B (NEOSPORIN) PACK,1602879,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SMX/TRIMETH 800/160MG (BACTRIM DS) TAB,1602881,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BENZTROPINE (COGENTIN) 1 MG TABLET,1603039,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BENZONATATE (TESSALON PERLE) 100 MG cap,1603040,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
POVIDONE-IODINE (BETADINE) 240 ML,1603305,CDM,250,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
SOTALOL (BETAPACE) 80 MG TABLET,1603334,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PENICILLIN G /BENZ (BICILLIN CR)1.2MIL U,1603494,CDM,636,RC,J0558,HCPCS,both,,,444,222,,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,17.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,333,75,,266.4,percent of total billed charges,75% of total billed charges for outpatient setting,333,75,,266.4,percent of total billed charges,75% of total billed charges for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,333,75,,266.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,346.32,78,,277.056,percent of total billed charges,78% of total billed charges for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,310.8,70,,248.64,percent of total billed charges,70% of total billed charges for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,333,75,,266.4,percent of total billed charges,75% of total billed charges for outpatient setting,368.52,83,,294.816,percent of total billed charges,83% of total billed charges for outpatient setting,222,50,,177.6,percent of total billed charges,50% of total billed charges for outpatient setting,222,50,,177.6,percent of total billed charges,50% of total billed charges for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.58,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,17.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.57,368.52,
PENICILLIN G BENZ (BICILLIN LA) 1.2MIL U,1603499,CDM,636,RC,J0561,HCPCS,both,,,557,278.5,,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,21.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,417.75,75,,334.2,percent of total billed charges,75% of total billed charges for outpatient setting,417.75,75,,334.2,percent of total billed charges,75% of total billed charges for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,417.75,75,,334.2,percent of total billed charges,75% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,434.46,78,,347.568,percent of total billed charges,78% of total billed charges for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,389.9,70,,311.92,percent of total billed charges,70% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,417.75,75,,334.2,percent of total billed charges,75% of total billed charges for outpatient setting,462.31,83,,369.848,percent of total billed charges,83% of total billed charges for outpatient setting,278.5,50,,222.8,percent of total billed charges,50% of total billed charges for outpatient setting,278.5,50,,222.8,percent of total billed charges,50% of total billed charges for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.73,462.31,
BISACODYL (DULCOLAX) 5 MG TABLET,1603551,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BISOCODYL (DULCOLAX) 10 MG SUPPOSITORY,1603552,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BLEOMYCIN SULF(BLENOXANE) 15UNIT VIAL,1603561,CDM,636,RC,J9040,HCPCS,both,,,1111.2,555.6,,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,833.4,75,,666.72,percent of total billed charges,75% of total billed charges for outpatient setting,833.4,75,,666.72,percent of total billed charges,75% of total billed charges for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,833.4,75,,666.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.07,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,866.74,78,,693.392,percent of total billed charges,78% of total billed charges for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,777.84,70,,622.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,833.4,75,,666.72,percent of total billed charges,75% of total billed charges for outpatient setting,922.3,83,,737.84,percent of total billed charges,83% of total billed charges for outpatient setting,555.6,50,,444.48,percent of total billed charges,50% of total billed charges for outpatient setting,555.6,50,,444.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.02,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.02,922.3,
ESMOLOL (BREVIBLOC) 10 MG/ML vial,1603619,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
BUMETANIDE (BUMEX) 1MG/4ML,1603762,CDM,250,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
BUMETANIDE (BUMEX) 2 MG TABLET,1603768,CDM,637,RC,,,outpatient,,,11.2,5.6,,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,38.4,,3.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.3,38.4,,3.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,35,,3.136,percent of total billed charges,35% of total billed charges for outpatient setting,8.74,78,,6.992,percent of total billed charges,78% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,83,,7.44,percent of total billed charges,83% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.39,39.17,,3.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.92,9.3,
BUSPIRONE (BUSPAR) 15 MG TABLET,1603812,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUTALBITAL/CAFFEINE/APAP (FIORICET) TAB,1603860,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CALCIUM GLUCONATE 10% 1GRAM/10ML vial,1603910,CDM,636,RC,J0612,HCPCS,both,,,13.5,6.75,,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,0.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.05,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.05,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.53,78,,8.424,percent of total billed charges,78% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,11.21,83,,8.968,percent of total billed charges,83% of total billed charges for outpatient setting,6.75,50,,5.4,percent of total billed charges,50% of total billed charges for outpatient setting,6.75,50,,5.4,percent of total billed charges,50% of total billed charges for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.05,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,0.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.04,11.21,
CALCIUM CHLORIDE 13.6MEQ (1GM) /10ML SYR,1603946,CDM,250,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
CALCIUM 600 MG TABLET,1603951,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CALCIUM CHL 1GM/10ML-EMS CHARGE ONLY,1604003,CDM,250,RC,,,outpatient,,,7.74,3.87,,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.97,38.4,,2.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.97,38.4,,2.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,5.81,75,,4.648,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,75,,4.648,percent of total billed charges,75% of total billed charges for outpatient setting,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,5.81,75,,4.648,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.71,35,,2.168,percent of total billed charges,35% of total billed charges for outpatient setting,6.04,78,,4.832,percent of total billed charges,78% of total billed charges for outpatient setting,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,5.42,70,,4.336,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.81,75,,4.648,percent of total billed charges,75% of total billed charges for outpatient setting,6.42,83,,5.136,percent of total billed charges,83% of total billed charges for outpatient setting,3.87,50,,3.096,percent of total billed charges,50% of total billed charges for outpatient setting,3.87,50,,3.096,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.03,39.17,,2.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.71,6.42,
CALCIUM 500MG + D (OYSTER CAL + D) TAB,1604035,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SUCRALFATE (CARAFATE) 1 GRAM TABLET,1604092,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARBIDOPA/LEVODOPA(SINEMET) 25/250MG TAB,1604124,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARBIDOPA/LEVODOPA(SINEMET) 25/100MG TAB,1604197,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DILTIAZEM CD (CARDIZEM) 120 MG capsule,1604216,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DILTIAZEM CD (CARDIZEM) 180 MG capsule,1604217,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DOXAZOSIN (CARDURA) 4 MG TABLET,1604226,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DILTIAZEM (CARDIZEM) 25MG/5ML VIAL,1604231,CDM,250,RC,,,outpatient,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
DILTIAZEM  (CARDIZEM) 300 MG ER 24HR CAP,1604233,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DILTIAZEM (CARDIZEM) 50MG/10ML,1604239,CDM,250,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CLONIDINE (CATAPRES TTS-1) 0.1 MG patch,1604373,CDM,637,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
CLONIDINE (CATAPRES TTS-2) 0.2 MG patch,1604374,CDM,637,RC,,,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.2,35,,42.56,percent of total billed charges,35% of total billed charges for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.54,39.17,,47.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.2,126.16,
CLONIDINE (CATAPRES TTS-3) 0.3 MG PATCH,1604375,CDM,637,RC,,,outpatient,,,146,73,,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.06,38.4,,44.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.06,38.4,,44.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,109.5,75,,87.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.5,75,,87.6,percent of total billed charges,75% of total billed charges for outpatient setting,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,109.5,75,,87.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.1,35,,40.88,percent of total billed charges,35% of total billed charges for outpatient setting,113.88,78,,91.104,percent of total billed charges,78% of total billed charges for outpatient setting,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,102.2,70,,81.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.5,75,,87.6,percent of total billed charges,75% of total billed charges for outpatient setting,121.18,83,,96.944,percent of total billed charges,83% of total billed charges for outpatient setting,73,50,,58.4,percent of total billed charges,50% of total billed charges for outpatient setting,73,50,,58.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.18,39.17,,45.744,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,51.1,121.18,
CEFAZOLIN (ANCEF) 1 GRAM vial,1604539,CDM,250,RC,J0690,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.76,4.15,
CEFUROXIME (CEFTIN) 250 MG TABLET,1604575,CDM,637,RC,,,outpatient,,,9.8,4.9,,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.76,38.4,,3.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.76,38.4,,3.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.43,35,,2.744,percent of total billed charges,35% of total billed charges for outpatient setting,7.64,78,,6.112,percent of total billed charges,78% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,83,,6.504,percent of total billed charges,83% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,39.17,,3.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.43,8.13,
CEPHALEXIN (KEFLEX) 500 MG capsule,1604814,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACTIVATED CHARCOAL W/SORBTL 50 GR/240ML,1604895,CDM,637,RC,,,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.5,58.1,
CHLORPROMAZINE (THORAZINE) 25 MG TABLET,1605286,CDM,637,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
BENZOCAINE/MENTHOL (CHLORASEPTIC) LOZ,1605288,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LORATADINE (CLARITIN) 10 MG TABLET,1605786,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLINDAMYCIN (CLEOCIN) 150 MG capsule,1605829,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLINDAMYCIN(CLEOCIN) D5W 300MG/50ML IVPB,1605840,CDM,250,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
CLINDAMYCIN(CLEOCIN) D5W 600MG/50ML IVPB,1605843,CDM,250,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
CLINDAMYCIN (CLEOCIN) 900 MG/50ML IVPB,1605846,CDM,250,RC,,,outpatient,,,21.1,10.55,,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.1,38.4,,6.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.1,38.4,,6.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.39,35,,5.912,percent of total billed charges,35% of total billed charges for outpatient setting,16.46,78,,13.168,percent of total billed charges,78% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,17.51,83,,14.008,percent of total billed charges,83% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.26,39.17,,6.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.39,17.51,
CLINDAMYCIN PHOS (CLEOCIN) 600MG/4ML VL,1605878,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
CLONIDINE (CATAPRES) 0.1 MG TABLET,1605951,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLONIDINE (CATAPRES) 0.2MG/1TAB,1606005,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLONIDINE (CATAPRES) 0.3 MG TABLET,1606033,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLOTRIMAZOLE (LOTRIMIN) 1% CREAM 30G,1606171,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROCHLORPERAZINE (COMPAZINE) 10 MG TAB,1606402,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMIODARONE (CORDARONE) 200 MG TABLET,1606441,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
COSYNTROPIN (CORTROSYN) 0.25MG VIAL,1606490,CDM,636,RC,J0834,HCPCS,both,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.11,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.11,63.91,
WARFARIN (COUMADIN) 5 MG TABLET,1606516,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
WARFARIN (COUMADIN) 10 MG TABLET,1606519,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
WARFARIN (COUMADIN) 2.5 MG TABLET,1606529,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LOSARTAN (COZAAR) 50 MG TABLET,1606545,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CYANOCOBALAMIN (VITAMIN B12) 1000MCG vl,1606573,CDM,637,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
CYPROHEPTADINE (PERIACTIN) 4 MG TABLET,1606773,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DEXTROSE 10%-WATER 1000ML,1606815,CDM,250,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
DEXTROSE 5%-0.2% SALINE 1000ML,1606820,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
D5 1/2 NS+20MEQ KCL 1000ML,1606822,CDM,250,RC,,,outpatient,,,12.6,6.3,,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.41,35,,3.528,percent of total billed charges,35% of total billed charges for outpatient setting,9.83,78,,7.864,percent of total billed charges,78% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,10.46,83,,8.368,percent of total billed charges,83% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.94,39.17,,3.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.41,10.46,
DEXTROSE 5%-0.45% SALINE 1000ML,1606825,CDM,250,RC,,,outpatient,,,12.6,6.3,,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.41,35,,3.528,percent of total billed charges,35% of total billed charges for outpatient setting,9.83,78,,7.864,percent of total billed charges,78% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,10.46,83,,8.368,percent of total billed charges,83% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.94,39.17,,3.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.41,10.46,
DEXTROSE 5%-LACTATED RINGERS 1000ML,1606828,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
DEXTROSE 5%-NORMAL SALINE 1000ML,1606829,CDM,258,RC,J7042,HCPCS,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,6.31,
DEXTROSE 5%-WATER 100ML,1606833,CDM,250,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
DEXTROSE 5%-WATER 1000ML,1606834,CDM,258,RC,J7060,HCPCS,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,11.62,
DEXTROSE 5%-WATER 250ML,1606836,CDM,258,RC,J7060,HCPCS,outpatient,,,16.04,8.02,,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.51,78,,10.008,percent of total billed charges,78% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,13.31,83,,10.648,percent of total billed charges,83% of total billed charges for outpatient setting,8.02,50,,6.416,percent of total billed charges,50% of total billed charges for outpatient setting,8.02,50,,6.416,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,13.31,
DEXTROSE 5%-WATER 50ML,1606837,CDM,258,RC,J7060,HCPCS,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,4.98,
DEXTROSE 5%-WATER 500ML,1606838,CDM,258,RC,J7060,HCPCS,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,4.98,
EYE WASH (DACRIOSE) BOTTLE,1606840,CDM,637,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
DANTROLENE SODIUM (DANTRIUM) 20mg VIAL,1606880,CDM,250,RC,,,outpatient,,,231,115.5,,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.85,35,,64.68,percent of total billed charges,35% of total billed charges for outpatient setting,180.18,78,,144.144,percent of total billed charges,78% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,191.73,83,,153.384,percent of total billed charges,83% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,115.5,50,,92.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.47,39.17,,72.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,80.85,191.73,
CARBAMIDE PEROXIDE EAR WAX DROPS,1606918,CDM,637,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
TORSEMIDE (DEMADEX) 20 MG TABLET,1607038,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VALPROIC ACID (DEPAKENE) 250 MG SOLUTION,1607086,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METHYLPREDNISOLONE (DEPO-MEDROL) 40MG VL,1607101,CDM,636,RC,J1030,HCPCS,both,,,21.1,10.55,,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.46,78,,13.168,percent of total billed charges,78% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,17.51,83,,14.008,percent of total billed charges,83% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.42,17.51,
DEFEROXAMINE (DESFERAL) 500MG VIAL,1607123,CDM,250,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
DEXAMETHASONE (DECADRON) 4 MG TABLET,1607355,CDM,250,RC,J8540,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DEXAMETHASONE (DECADRON) 4 MG vial,1607422,CDM,636,RC,J1100,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,4.15,
DEXTROSE 25%-WATER 2.5GRAMS/10ML,1607544,CDM,258,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
DEXTROSE 50% PFS 25 GRAM/50ML syringe,1607577,CDM,258,RC,,,outpatient,,,23.63,11.82,,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.07,38.4,,7.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.07,38.4,,7.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.27,35,,6.616,percent of total billed charges,35% of total billed charges for outpatient setting,18.43,78,,14.744,percent of total billed charges,78% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,19.61,83,,15.688,percent of total billed charges,83% of total billed charges for outpatient setting,11.82,50,,9.456,percent of total billed charges,50% of total billed charges for outpatient setting,11.82,50,,9.456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.25,39.17,,7.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.27,19.61,
DIAZEPAM (VALIUM) 2 MG TABLET,1607732,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIAZEPAM (VALIUM) 10 MG AMP,1607855,CDM,250,RC,,,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,35,,26.04,percent of total billed charges,35% of total billed charges for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.42,39.17,,29.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.55,77.19,
DIAZEPAM 5 MG (VALIUM) TABLET,1607901,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DICLOXACILLIN (DYNAPEN) 250 MG capsule,1607941,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DICYCLOMINE (BENTYL) 10 MG capsule,1607967,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DICYCLOMINE (BENTYL) 20 MG / 2 ML VIAL,1607977,CDM,250,RC,,,outpatient,,,177.8,88.9,,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.28,38.4,,54.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.28,38.4,,54.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.23,35,,49.784,percent of total billed charges,35% of total billed charges for outpatient setting,138.68,78,,110.944,percent of total billed charges,78% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,147.57,83,,118.056,percent of total billed charges,83% of total billed charges for outpatient setting,88.9,50,,71.12,percent of total billed charges,50% of total billed charges for outpatient setting,88.9,50,,71.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,39.17,,55.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,62.23,147.57,
FLUCONAZOLE PREMIX (DIFLUCAN) 400MG BAG,1608054,CDM,250,RC,J1450,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,12.45,
FLUCONAZOLE (DIFLUCAN) 200 MG IV,1608065,CDM,250,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
PHENYTOIN (DILANTIN) 100 MG capsule,1608111,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENYTOIN (DILANTIN) 100 MG vial,1608114,CDM,250,RC,J1165,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,4.15,
PHENYTOIN (DILANTIN) 250 MG vial,1608123,CDM,250,RC,J1165,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,4.15,
DILTIAZEM (CARDIZEM) 30 MG TABLET,1608245,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIMENHYDRINATE (DRAMAMINE) 50 MG TABLET,1608298,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIPHENOX/ATROP (LOMOTIL) 2.5/0.025MG TAB,1608383,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIPHENHYDRAMINE (BENADRYL) 25 MG capsule,1608390,CDM,637,RC,Q0163,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIPHENHYDRAMINE (BENADRYL) 50MG ML,1608441,CDM,636,RC,J1200,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,4.15,
DIPHENHYDRAMINE (BENADRYL) SOL 12.5MG,1608521,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OXYBUTYNIN ER (DITROPAN) 5 MG TABLET,1608757,CDM,637,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
DOBUTAMINE(DOBUTREX) 250MG/250ML BAG,1608781,CDM,636,RC,J1250,HCPCS,both,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.34,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.85,20.75,
DOCUSATE SODIUM (COLACE) 100 MG capsule,1608869,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DOPamine/DEXTROSE 5%WATER 400MG/500ML,1608960,CDM,636,RC,J1265,HCPCS,both,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
DOXEPIN (SILENOR) 25 MG capsule,1609151,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DOXYCYCLINE (VIBRAMYCIN) 100 MG TABLET,1609266,CDM,637,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
DOXYCYCLINE (VIBRAMYCIN) 100MG  VIAL,1609308,CDM,637,RC,,,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.1,54.78,
FENTANYL (DURAGESIC) 100 MCG patch,1609376,CDM,637,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FENTANYL (DURAGESIC) 50 MCG patch,1609378,CDM,637,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
FENTANYL (DURAGESIC) 75 MCG patch,1609379,CDM,637,RC,,,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.85,35,,19.88,percent of total billed charges,35% of total billed charges for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.81,39.17,,22.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.85,58.93,
VENLAFAXINE (EFFEXOR) 75 MG TABLET,1609516,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VENLAFAXINE ER (EFFEXOR XR) 37.5 MG cap,1609519,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VENLAFAXINE ER (EFFEXOR XR) 75 MG cap,1609524,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HEP B VIR VACC RCMB(ENGERIX-B) 20MCG/1ML,1609667,CDM,250,RC,90746,HCPCS,outpatient,,,197,98.5,,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,153.66,78,,122.928,percent of total billed charges,78% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,163.51,83,,130.808,percent of total billed charges,83% of total billed charges for outpatient setting,98.5,50,,78.8,percent of total billed charges,50% of total billed charges for outpatient setting,98.5,50,,78.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.38,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.38,163.51,
EPHEDRINE (AKOVAZ) 50 MG/ML  VIAL,1609709,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
EPINEPHRINE PREFILLED 1MG/10ML SYRINGE,1609710,CDM,250,RC,,,outpatient,,,17.72,8.86,,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.8,38.4,,5.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.8,38.4,,5.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,13.29,75,,10.632,percent of total billed charges,75% of total billed charges for outpatient setting,13.29,75,,10.632,percent of total billed charges,75% of total billed charges for outpatient setting,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,13.29,75,,10.632,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.2,35,,4.96,percent of total billed charges,35% of total billed charges for outpatient setting,13.82,78,,11.056,percent of total billed charges,78% of total billed charges for outpatient setting,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,12.4,70,,9.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.29,75,,10.632,percent of total billed charges,75% of total billed charges for outpatient setting,14.71,83,,11.768,percent of total billed charges,83% of total billed charges for outpatient setting,8.86,50,,7.088,percent of total billed charges,50% of total billed charges for outpatient setting,8.86,50,,7.088,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.94,39.17,,5.552,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.2,14.71,
ERYTHROMYCIN (ILOTYCIN) OPHTH 1 GRAM,1609987,CDM,637,RC,,,outpatient,,,20.26,10.13,,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.78,38.4,,6.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.78,38.4,,6.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.09,35,,5.672,percent of total billed charges,35% of total billed charges for outpatient setting,15.8,78,,12.64,percent of total billed charges,78% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,14.18,70,,11.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.2,75,,12.16,percent of total billed charges,75% of total billed charges for outpatient setting,16.82,83,,13.456,percent of total billed charges,83% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,10.13,50,,8.104,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.94,39.17,,6.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.09,16.82,
ESTRADIOL (ESTRACE) 1 MG TABLET,1610038,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FENTANYL (SUBLIMAZE) 100 MCG/2ML INJ,1610239,CDM,636,RC,J3010,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,4.15,
FENTANYL (SUBLIMAZE) 250 MCG INJECTION,1610240,CDM,636,RC,J3010,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,4.15,
FERROUS SULFATE 325MG TABLET,1610341,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETAMINOPHEN (TYLENOL) 120MG SUPP,1610399,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETAMINOPHEN (TYLENOL) 325 MG SUPP,1610401,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETAMINOPHEN (TYLENOL) 650 MG SUPP,1610402,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLANDERS OINTMENT,1610472,CDM,637,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
SODIUM PHOSPHATE (FLEET) ENEMA 133ML,1610475,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CYCLOBENZAPRINE (FLEXERIL) 10 MG TABLET,1610478,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUTICASONE (FLONASE) NASAL SPR 50 MCG,1610481,CDM,637,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
FLUDROCORTISONE (FLORINEF) 0.1 MG TABLET,1610492,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUORESCEIN (BIO-GLO) STRIPS,1610671,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUOROURACIL 500MG/10ML VIAL,1610680,CDM,636,RC,J9190,HCPCS,both,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.38,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.22,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.22,11.62,
FLUZONE 0.5ML INJECTION,1610895,CDM,636,RC,90658,HCPCS,both,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.3,48.14,
FOLIC ACID (FOLVITE) 1 MG TABLET,1610916,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FOLIC ACID 50MG / 10ML multidose VIAL,1610937,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CEFTAZIDIME (FORTAZ) 2 GRAM VIAL,1610955,CDM,250,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
FUROSEMIDE (LASIX) 100 MG vial,1611004,CDM,636,RC,J1940,HCPCS,both,,,8.4,4.2,,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,6.55,78,,5.24,percent of total billed charges,78% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,6.97,83,,5.576,percent of total billed charges,83% of total billed charges for outpatient setting,4.2,50,,3.36,percent of total billed charges,50% of total billed charges for outpatient setting,4.2,50,,3.36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,6.97,
FUROSEMIDE (LASIX) 40 MG vial,1611021,CDM,636,RC,J1940,HCPCS,both,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,7.7,
FUROSEMIDE (LASIX) 20 MG vial,1611071,CDM,636,RC,J1940,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,4.15,
FUROSEMIDE (LASIX) 20 MG TABLET,1611088,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FUROSEMIDE (LASIX) 40 MG TABLET,1611126,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GEMFIBROZIL(LOPID) 600 MG TABLET,1611286,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OXYMETAZOLINE (AFRIN) BOTTLE NAS SPRAY,1611340,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GENTAMYCIN (GARAMYCIN) 80 MG/ 2 ML vial,1611393,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GENTAMICIN 0.1% OINTMENT 15GM,1611410,CDM,637,RC,,,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.35,35,,33.88,percent of total billed charges,35% of total billed charges for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.39,39.17,,37.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42.35,100.43,
GENTAMICIN (GARAMICIN) 0.3% OPTH SOL BTL,1611430,CDM,637,RC,,,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56.7,134.46,
METFORMIN ER 500 MG TABLET,1611532,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLIPIZIDE ER (GLUCOTROL XL) 2.5 MG TAB,1611594,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLIPIZIDE (GLUCOTROL) 5 MG TABLET,1611605,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLUCAGON 1 MG KIT,1611608,CDM,636,RC,J1610,HCPCS,both,,,994,497,,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,188.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,188.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,745.5,75,,596.4,percent of total billed charges,75% of total billed charges for outpatient setting,745.5,75,,596.4,percent of total billed charges,75% of total billed charges for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,745.5,75,,596.4,percent of total billed charges,75% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,775.32,78,,620.256,percent of total billed charges,78% of total billed charges for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,695.8,70,,556.64,percent of total billed charges,70% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,745.5,75,,596.4,percent of total billed charges,75% of total billed charges for outpatient setting,825.02,83,,660.016,percent of total billed charges,83% of total billed charges for outpatient setting,497,50,,397.6,percent of total billed charges,50% of total billed charges for outpatient setting,497,50,,397.6,percent of total billed charges,50% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,825.02,
GLIPIZIDE ER (GLUCOTROL XL) 5 MG TABLET,1611612,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLYBURIDE (GLYNASE) 5 MG TABLET,1611647,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLYCOPYRROLATE (ROBINOL) 0.2 MG VIAL,1611674,CDM,250,RC,,,outpatient,,,30.08,15.04,,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,38.4,,9.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.55,38.4,,9.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,22.56,75,,18.048,percent of total billed charges,75% of total billed charges for outpatient setting,22.56,75,,18.048,percent of total billed charges,75% of total billed charges for outpatient setting,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,22.56,75,,18.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.53,35,,8.424,percent of total billed charges,35% of total billed charges for outpatient setting,23.46,78,,18.768,percent of total billed charges,78% of total billed charges for outpatient setting,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,21.06,70,,16.848,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.56,75,,18.048,percent of total billed charges,75% of total billed charges for outpatient setting,24.97,83,,19.976,percent of total billed charges,83% of total billed charges for outpatient setting,15.04,50,,12.032,percent of total billed charges,50% of total billed charges for outpatient setting,15.04,50,,12.032,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.78,39.17,,9.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.53,24.97,
GLYCERIN PEDIATRIC 1GM SUPP,1611714,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PEG (GOLYTELY) 4000ML,1611733,CDM,250,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
GUAIFENESIN (ROBITUSSIN) 200MG / 10ML UD,1611786,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HALOPERIDOL (HALDOL) 5MG TABLET,1611947,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HALOPERIDOL (HALDOL) 1 MG TABLET,1611959,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HALOPERIDOL LACTATE (HALDOL) 5 MG VIAL,1611971,CDM,636,RC,J1630,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.49,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,4.15,
HYDROCHLOROTHIAZIDE(HYDRODIURIL)25MG TAB,1612287,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HEPARIN 5000 UNITS vial,1612432,CDM,250,RC,J1644,HCPCS,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.27,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.28,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.27,4.91,
HETASTARCH (HESPAN) 6% 500ml BAG,1612482,CDM,250,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
BENZOCAINE (HURRICANE) ORAL SPRAY,1612549,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
HYDROCORTISONE 1% cream,1612629,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDRALAZINE (APRESOLINE) 25 MG TABLET,1612751,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROCORTISONE 2.5% CREAM 30GM,1612849,CDM,637,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
HYDRALAZINE (APRESOLINE) 50 MG TABLET,1612859,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDRALAZINE (APRESOLINE) 20 MG/ML VIAL,1613033,CDM,250,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
HYDROCORTISONE (ANUSOL) 25 MG SUPP,1613111,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
HYDROXYZINE (ATARAX) 10 MG TABLET,1613246,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROXYZINE (ATARAX) 25 MG TABLET,1613290,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TERAZOSIN (HYTRIN) 1 MG capsule,1613506,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TERAZOSIN (HYTRIN) 5 MG capsule,1613508,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IBUPROFEN (MOTRIN) 200 MG TABLET,1613531,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ISOSORBIDE MONONIT ER (IMDUR) 60MG TAB,1613774,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SUMATRIPTAN (IMITREX) 6MG/0.5ML INJ,1613885,CDM,636,RC,J3030,HCPCS,both,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,62.75,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.89,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.75,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,65.89,
LOPERAMIDE (IMMODIUM) 2 MG capsule,1613891,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
RABIES IMMUNE GLOBULIN 300 UNITS / VIAL,1613892,CDM,636,RC,90376,HCPCS,both,,,1766,883,,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,479.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,678.14,38.4,,542.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,678.14,38.4,,542.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,1324.5,75,,1059.6,percent of total billed charges,75% of total billed charges for outpatient setting,1324.5,75,,1059.6,percent of total billed charges,75% of total billed charges for outpatient setting,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,1324.5,75,,1059.6,percent of total billed charges,75% of total billed charges for outpatient setting,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,618.1,35,,494.48,percent of total billed charges,35% of total billed charges for outpatient setting,1377.48,78,,1101.984,percent of total billed charges,78% of total billed charges for outpatient setting,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,1236.2,70,,988.96,percent of total billed charges,70% of total billed charges for outpatient setting,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1324.5,75,,1059.6,percent of total billed charges,75% of total billed charges for outpatient setting,1465.78,83,,1172.624,percent of total billed charges,83% of total billed charges for outpatient setting,883,50,,706.4,percent of total billed charges,50% of total billed charges for outpatient setting,883,50,,706.4,percent of total billed charges,50% of total billed charges for outpatient setting,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,691.7,39.17,,553.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,479.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,479.72,1465.78,
RABIES (RABAVERT) 2.5 IU/1ML VACCINE,1613894,CDM,636,RC,90675,HCPCS,both,,,1101,550.5,,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,324.74,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,324.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,324.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,825.75,75,,660.6,percent of total billed charges,75% of total billed charges for outpatient setting,825.75,75,,660.6,percent of total billed charges,75% of total billed charges for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,825.75,75,,660.6,percent of total billed charges,75% of total billed charges for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,340.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,858.78,78,,687.024,percent of total billed charges,78% of total billed charges for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,770.7,70,,616.56,percent of total billed charges,70% of total billed charges for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,825.75,75,,660.6,percent of total billed charges,75% of total billed charges for outpatient setting,913.83,83,,731.064,percent of total billed charges,83% of total billed charges for outpatient setting,550.5,50,,440.4,percent of total billed charges,50% of total billed charges for outpatient setting,550.5,50,,440.4,percent of total billed charges,50% of total billed charges for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.74,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,324.74,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.74,913.83,
ISOSORBID MONONITRATE (IMDUR) 20 MG TAB,1614260,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ISOSORBIDE DINITRATE (ISORDIL) 10 MG TAB,1614473,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
POTASSIUM CHLORIDE 40 MEQ/20ML vial,1614723,CDM,250,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
POTASSIUM CHLORIDE (KLOR-CON) 20 MEQ TAB,1614759,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TRIAMCINOLONE (KENALOG) 40 MG vial,1614806,CDM,250,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
LEVETIRACETAM (KEPPRA) 250 MG TABLET,1614825,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLONAZEPAM (KLONOPIN) 1 MG TABLET,1614874,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLONAZEPAM (KLONOPIN) 0.5 MG TABLET,1614877,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIGOXIN (LANOXIN) 0.125 MG TABLET,1615053,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DIGOXIN (LANOXIN) 0.5MG/2ML AMP,1615064,CDM,250,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
LEVOTHYROXINE (SYNTHROID) 88 MCG TABLET,1615255,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NOREPINEPHRINE (LEVOPHED) 4mg/4ml vial,1615347,CDM,250,RC,,,outpatient,,,21.94,10.97,,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.42,38.4,,6.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.42,38.4,,6.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,35,,6.144,percent of total billed charges,35% of total billed charges for outpatient setting,17.11,78,,13.688,percent of total billed charges,78% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,18.21,83,,14.568,percent of total billed charges,83% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.59,39.17,,6.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.68,18.21,
HYOSCYAMINE (LEVSIN) 0.125MG TAB,1615355,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LIDOCAINE JELLY 2% 30GRAM,1615462,CDM,637,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
LIDOCAINE/D5W PREMIX 2 GRAM/250ML BAG,1615491,CDM,250,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
LIDOCAINE VISCOUS 2% UD 300MG/15ML,1615493,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LITHIUM (LITHOBID) 300 MG capsule,1615648,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METOPROLOL (LOPRESSOR) 5 MG / 5ml VIAL,1615770,CDM,250,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
LORAZEPAM (ATIVAN) 1 MG TABLET,1615885,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LORAZEPAM (ATIVAN) 0.5 MG TABLET,1615926,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROCOD 2.5MG/APAP 108MG (LORTAB) 5ML,1615944,CDM,637,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
BENAZEPRIL (LOTENSIN) 10 MG TABLET,1615948,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CLOTRIM / BETAMTH (LOTRISONE) 15GR CRM,1615969,CDM,637,RC,,,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
ENOXAPARIN (LOVENOX) 30 MG syringe,1615971,CDM,636,RC,J1650,HCPCS,both,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
RINGERS LACTATED SOL IV 1000ML,1616041,CDM,636,RC,J7120,HCPCS,both,,,6.75,3.38,,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.27,78,,4.216,percent of total billed charges,78% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,83,,4.48,percent of total billed charges,83% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,5.6,
"MAG,ALUM,SIMETHI (MAALOX) 30ML CUP",1616161,CDM,637,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
NITROFURANTOIN (MACROBID) 100 MG capsule,1616174,CDM,637,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
MAGNESIUM CITRATE SOLUTION BOTTLE,1616184,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MAGNESIUM OXIDE 400 MG TABLET,1616224,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MAGNESIUM SULFATE 1GM/2ML INJ,1616226,CDM,636,RC,J3475,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,4.15,
MANNITOL (OSMITROL) 20% 500ML BAG,1616280,CDM,250,RC,,,outpatient,,,260,130,,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.84,38.4,,79.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.84,38.4,,79.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91,35,,72.8,percent of total billed charges,35% of total billed charges for outpatient setting,202.8,78,,162.24,percent of total billed charges,78% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,182,70,,145.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,195,75,,156,percent of total billed charges,75% of total billed charges for outpatient setting,215.8,83,,172.64,percent of total billed charges,83% of total billed charges for outpatient setting,130,50,,104,percent of total billed charges,50% of total billed charges for outpatient setting,130,50,,104,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.84,39.17,,81.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,91,215.8,
BUPIVACAINE (MARCAINE) 0.75% 2ML AMP,1616386,CDM,250,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
MECLIZINE (ANTIVERT) 25 MG TABLET,1616510,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MEGESTROL (MEGACE) 40 MG TABLET,1616669,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MEPERIDINE (DEMEROL) 100MG AMP,1616709,CDM,636,RC,J2175,HCPCS,both,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,7.67,
MEPERIDINE (DEMEROL) 50 MG INJECTION,1616731,CDM,636,RC,J2175,HCPCS,both,,,10.97,5.49,,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.56,78,,6.848,percent of total billed charges,78% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,9.11,83,,7.288,percent of total billed charges,83% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,9.11,
METHYLPREDNISOLONE (MEDROL) PACK 4MG TAB,1617336,CDM,637,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
METHOTREXATE (TREXALL) 2.5 MG TABLET,1617359,CDM,250,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
METOCLOPRAMIDE (REGLAN) 10MG/2ML VlAL,1617417,CDM,636,RC,J2765,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,4.15,
METOCLOPRAMIDE (REGLAN) 10 MG TABLET,1617426,CDM,636,RC,J2765,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.09,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,4.15,
METOPROLOL (LOPRESSOR) 50 MG TABLET,1617536,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METRONIDAZOLE (FLAGYL) 500 MG TABLET,1617669,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METRONIDAZOLE (FLAGYL) 500MG/100ML IVPB,1617679,CDM,250,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
LOVASTATIN (MEVACOR) 20 MG TABLET,1617687,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MICONAZOLE NITRATE(MONISTAT) VAGINAL CRM,1617752,CDM,637,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
MAG HYDROX(MILK OF MAGNESIA) 30ML SUSP,1617837,CDM,637,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
MINERAL OIL 30ML CUP,1617849,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MINOXIDIL (LONITEN) 2.5 MG TABLET,1617887,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FOSINOPRIL (MONOPRIL) 20 mg TABLET,1618005,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MORPHINE ER (MS CONTIN) 15 MG TABLET,1618190,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETYLCYSTEINE (MUCOMYST) 800MG/4ML VIAL,1618232,CDM,637,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
SOD. CHLOR 5% (MURO-128) EYE DROPS drops,1618312,CDM,637,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
MULTIVITAMIN 10ML INJECTION,1618326,CDM,250,RC,,,outpatient,,,19.41,9.71,,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.79,35,,5.432,percent of total billed charges,35% of total billed charges for outpatient setting,15.14,78,,12.112,percent of total billed charges,78% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,16.11,83,,12.888,percent of total billed charges,83% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.6,39.17,,6.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.79,16.11,
NYSTATIN POWDER 15GM,1618373,CDM,637,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
NAPROXEN (NAPROSYN) 500 MG TABLET,1618683,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NALOXONE (NARCAN) 0.4 MG vial,1618827,CDM,636,RC,J2310,HCPCS,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.29,23.24,
TOBRAMYCIN (NEBCIN) 80 MG vial,1618891,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
PHENYLEPHRINE (NEO-SYNEPHRINE) 0.5% BTL,1618927,CDM,637,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
NEOM/POLYMIX/GRAMICIDIN(NEOSPORIN) BTL,1618935,CDM,637,RC,,,outpatient,,,181,90.5,,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.5,38.4,,55.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.5,38.4,,55.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.35,35,,50.68,percent of total billed charges,35% of total billed charges for outpatient setting,141.18,78,,112.944,percent of total billed charges,78% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.23,83,,120.184,percent of total billed charges,83% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.89,39.17,,56.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63.35,150.23,
HYDROCT/NEOMY/PLYMIX EAR(CORTISPORIN)BTL,1618947,CDM,637,RC,,,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56.7,134.46,
NEOSTIGMINE (PROSTIGMIN) 10MG/10ML VIAL,1619015,CDM,250,RC,,,outpatient,,,127.4,63.7,,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.59,35,,35.672,percent of total billed charges,35% of total billed charges for outpatient setting,99.37,78,,79.496,percent of total billed charges,78% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,105.74,83,,84.592,percent of total billed charges,83% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.9,39.17,,39.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.59,105.74,
FILGRASTIM (NEUPOGEN) 480MCG/0.8ML,1619044,CDM,636,RC,J1442,HCPCS,both,,,19186,9593,,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,0.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,0.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.99,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,14389.5,75,,11511.6,percent of total billed charges,75% of total billed charges for outpatient setting,14389.5,75,,11511.6,percent of total billed charges,75% of total billed charges for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,14389.5,75,,11511.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1.04,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14965.08,78,,11972.064,percent of total billed charges,78% of total billed charges for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,13430.2,70,,10744.16,percent of total billed charges,70% of total billed charges for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14389.5,75,,11511.6,percent of total billed charges,75% of total billed charges for outpatient setting,15924.38,83,,12739.504,percent of total billed charges,83% of total billed charges for outpatient setting,9593,50,,7674.4,percent of total billed charges,50% of total billed charges for outpatient setting,9593,50,,7674.4,percent of total billed charges,50% of total billed charges for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.99,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,0.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.99,15924.38,
GABAPENTIN (NEURONTIN) 100 MG capsule,1619045,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GABAPENTIN (NEURONTIN) 400 MG capsule,1619047,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GABAPENTIN (NEURONTIN) 300 MG capsule,1619050,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHOS-NaK (NEUTRA-PHOS) PACK,1619056,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NICOTINE (NICODERM) 21 MG patch,1619160,CDM,637,RC,,,outpatient,,,5.06,2.53,,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.77,35,,1.416,percent of total billed charges,35% of total billed charges for outpatient setting,3.95,78,,3.16,percent of total billed charges,78% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,83,,3.36,percent of total billed charges,83% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.98,39.17,,1.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.77,4.2,
NITROGLYCERIN/D5W 25MG/250ML,1619402,CDM,250,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
NITROGLYCERIN (NITRO-BID) 2% OINT PCKT,1619403,CDM,637,RC,,,outpatient,,,6.75,3.38,,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.36,35,,1.888,percent of total billed charges,35% of total billed charges for outpatient setting,5.27,78,,4.216,percent of total billed charges,78% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,83,,4.48,percent of total billed charges,83% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.64,39.17,,2.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.36,5.6,
NITROGLYCERIN SUBLG(NITROSTAT) 0.4MG TAB,1619418,CDM,637,RC,,,outpatient,,,61.61,30.81,,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.66,38.4,,18.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.66,38.4,,18.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,46.21,75,,36.968,percent of total billed charges,75% of total billed charges for outpatient setting,46.21,75,,36.968,percent of total billed charges,75% of total billed charges for outpatient setting,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,46.21,75,,36.968,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.56,35,,17.248,percent of total billed charges,35% of total billed charges for outpatient setting,48.06,78,,38.448,percent of total billed charges,78% of total billed charges for outpatient setting,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,43.13,70,,34.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.21,75,,36.968,percent of total billed charges,75% of total billed charges for outpatient setting,51.14,83,,40.912,percent of total billed charges,83% of total billed charges for outpatient setting,30.81,50,,24.648,percent of total billed charges,50% of total billed charges for outpatient setting,30.81,50,,24.648,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.13,39.17,,19.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.56,51.14,
NITROGLYCERIN (NITRO-DUR) 0.4 MG patch,1619431,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KETOCONAZOLE (NIZORAL) 2% cream,1619448,CDM,637,RC,,,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.5,58.1,
VECURONIUM (NORCURON) 10 MG vial,1619475,CDM,250,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
ORPHENADRINE (NORFLEX) 60MG/2ml AMP,1619484,CDM,636,RC,J2360,HCPCS,both,,,15.4,7.7,,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.71,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,12.01,78,,9.608,percent of total billed charges,78% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,12.78,83,,10.224,percent of total billed charges,83% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,12.78,
LABETALOL (TRANDATE) 100 MG TABLET,1619499,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LABETALOL (TRANDATE) 100MG/20ML vial,1619510,CDM,250,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
AMLODIPINE (NORVASC) 10 MG TABLET,1619629,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMLODIPINE (NORVASC) 5 MG TABLET,1619632,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
INSULIN NPH/REG (HUMULIN) 70/30 VL,1619676,CDM,637,RC,J1815,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,4.15,
INSULIN NPH (HUMULIN N) 100UNITS/1ML VL,1619684,CDM,636,RC,J1815,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,4.15,
SODIUM CHLORIDE 0.9% 100ML BAG NO ADAPT,1619690,CDM,250,RC,,,outpatient,,,5.06,2.53,,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.77,35,,1.416,percent of total billed charges,35% of total billed charges for outpatient setting,3.95,78,,3.16,percent of total billed charges,78% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,83,,3.36,percent of total billed charges,83% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.98,39.17,,1.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.77,4.2,
SODIUM CHLORIDE 0.9% 1BAG 1000ML,1619691,CDM,258,RC,,,outpatient,,,6.75,3.38,,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.36,35,,1.888,percent of total billed charges,35% of total billed charges for outpatient setting,5.27,78,,4.216,percent of total billed charges,78% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,83,,4.48,percent of total billed charges,83% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.64,39.17,,2.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.36,5.6,
NORMAL SALINE 250ML BAG,1619693,CDM,258,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
NORMAL SALINE 50ML BAG,1619694,CDM,250,RC,,,outpatient,,,5.06,2.53,,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.77,35,,1.416,percent of total billed charges,35% of total billed charges for outpatient setting,3.95,78,,3.16,percent of total billed charges,78% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,83,,3.36,percent of total billed charges,83% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.98,39.17,,1.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.77,4.2,
NORMAL SALINE 500ML BAG,1619695,CDM,636,RC,J7040,HCPCS,both,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,4.91,
NACL .9%/KCL 20 MEQ 1000ML,1619696,CDM,250,RC,,,outpatient,,,8.44,4.22,,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.95,35,,2.36,percent of total billed charges,35% of total billed charges for outpatient setting,6.58,78,,5.264,percent of total billed charges,78% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,7.01,83,,5.608,percent of total billed charges,83% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,39.17,,2.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.95,7.01,
IRON POLYSACCHARIDE (NU-IRON) 150 MG cap,1619720,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NYSTATIN (NYSTOP) OINTMENT,1619767,CDM,637,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
NYSTATIN (NYSTOP) cream,1619798,CDM,637,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
SALINE (OCEAN) NASAL SPRAY BOTTLE,1619911,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OCUVITE (I-VITE) TABLET,1619927,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VALSARTAN (DIOVAN) 80 MG TABLET,1620074,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OXYBUTYNIN (DITROPAN) 5 MG TABLET,1620279,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PAROXETINE (PAXIL) 10 MG TABLET,1620519,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PAROXETINE (PAXIL) 20MG TABLET,1620522,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
"PETROLATUM,WHITE (VASELINE) JELLY",1620987,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENOL/SODIUM PH (CHLORASEPTIC)SPR 180ML,1621028,CDM,637,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
PROMETHAZINE HCL (PHENERGAN) 25MG SUPP,1621057,CDM,637,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
PHENOBARBITAL 30 MG TABLET,1621059,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENYLEPHRINE (NEO-SYNEPHRINE) 10MG/ML,1621273,CDM,636,RC,J2370,HCPCS,both,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
PHENYTOIN (DILANTIN) 100 MG/4 ML susp,1621280,CDM,637,RC,J1165,HCPCS,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.63,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,16.6,
OXYTOCIN (PITOCIN) 10 UNITS vial,1621575,CDM,250,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
HYDROXYCHLOROQUINE (PLAQUENIL) 200MG TAB,1621588,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
TRIMETH/POLYMYX (POLYTRIM) OPTH,1621671,CDM,637,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
POTASSIUM CHLORIDE 20 mEq 15ML CUP,1621781,CDM,637,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
POTASSIUM CHLORIDE (KLOR-CON) 10 MEQ TAB,1621791,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
POTASSIUM PHOSPHATES 15MMOL / 5ML,1621940,CDM,250,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
PRAVASTATIN (PRAVACHOL) 20 MG TABLET,1622021,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREDNISONE 10 MG TABLET,1622133,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREDNISOLONE (AK-PRED) 1% OPHTH SOLN BTL,1622145,CDM,637,RC,,,outpatient,,,164,82,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.4,35,,45.92,percent of total billed charges,35% of total billed charges for outpatient setting,127.92,78,,102.336,percent of total billed charges,78% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,136.12,83,,108.896,percent of total billed charges,83% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.24,39.17,,51.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.4,136.12,
PREDNISONE 20 MG TABLET,1622158,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREDNISONE 5 MG TABLET,1622272,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENYLEPHRINE 0.25% (PREPARATION-H) SUPP,1622407,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LANSOPRAZOLE (PREVACID) 30 MG capsule,1622412,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LISINOPRIL (PRINVIL/ZESTRIL) 5 MG TABLET,1622488,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROMETHAZINE (PHENERGAN) 25 MG TABLET,1622784,CDM,637,RC,Q0169,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROMETHAZINE (PHENERGAN) 25MG/ML VIAL,1622792,CDM,636,RC,J2550,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.5,4.15,
PROPRANOLOL (INDERAL) 10 MG TABLET,1623195,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FINASTERIDE (PROSCAR) 5MG TABLET,1623393,CDM,637,RC,,,outpatient,,,9.8,4.9,,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.76,38.4,,3.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.76,38.4,,3.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.43,35,,2.744,percent of total billed charges,35% of total billed charges for outpatient setting,7.64,78,,6.112,percent of total billed charges,78% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,83,,6.504,percent of total billed charges,83% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,39.17,,3.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.43,8.13,
PROTAMINE 50MG/5ML vial,1623410,CDM,250,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
FLUOXETINE (PROZAC) 10 MG capsule,1623443,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUOXETINE (PROZAC) 20 MG capsule,1623445,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENAZOPYRIDINE (PYRIDIUM) 100 MG TABLET,1623557,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PYRIDOXIME (VITAMIN B-6) 50 MG TABLET,1623567,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GUAIFENESIN (MUCINEX) 600 MG TABLET,1623629,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CHOLESTYRAMINE (QUESTRAN) 4GM PACKET,1623645,CDM,637,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
ZIDOVUDINE (RETROVIR) 100MG CAPSULE,1623989,CDM,637,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
RIFAMPIN (RIFADIN) 300 MG capsule,1624019,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
RISPERIDONE (RISPERDAL) 1 MG TABLET,1624040,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METHOCARBAMOL (ROBAXIN) 500 MG TABLET,1624064,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GUAIFEN/CODEINE (ROBITUSSIN AC) 10 ML,1624081,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CALCITRIOL (ROCALTROL) 0.25 MCG capsule,1624108,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CEFTRIAXONE (ROCEPHIN) 2 GRAM VIAL,1624118,CDM,250,RC,,,outpatient,,,8.44,4.22,,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.95,35,,2.36,percent of total billed charges,35% of total billed charges for outpatient setting,6.58,78,,5.264,percent of total billed charges,78% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,7.01,83,,5.608,percent of total billed charges,83% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,39.17,,2.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.95,7.01,
OSELTAMIVIR (TAMIFLU) 75 MG capsule,1624119,CDM,637,RC,,,outpatient,,,24.48,12.24,,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,38.4,,7.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.4,38.4,,7.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.57,35,,6.856,percent of total billed charges,35% of total billed charges for outpatient setting,19.09,78,,15.272,percent of total billed charges,78% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,17.14,70,,13.712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.36,75,,14.688,percent of total billed charges,75% of total billed charges for outpatient setting,20.32,83,,16.256,percent of total billed charges,83% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,12.24,50,,9.792,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.59,39.17,,7.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.57,20.32,
CEFTRIAXONE (ROCEPHIN) 250 MG VIAL,1624121,CDM,636,RC,J0696,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,4.15,
FLUMAZENIL (ROMAZICON) 0.5MG/5ML vial,1624139,CDM,250,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
OXYCODONE IR (ROXICODONE) 5 MG TAB,1624177,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OXYCODONE 5MG/APAP 325MG (PERCOCET) TAB,1624188,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM CL IRRIG SOLN 1000ML,1624246,CDM,250,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
SENNA-S (SENOKOT-S) 8.6MG TABLET,1624398,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUPIVACAINE(SENSORCAINE) 25MG/10ML MPF,1624406,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUPIVACAINE(SENSORCAINE) 50MG/10ML VL,1624412,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUPIVACAINE(SENSORCAINE) 150MG/30ML VL,1624413,CDM,250,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
sulfamethox/trimeth (SEPTRA) 5 ML INJ,1624430,CDM,250,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
SILVER NITRATE APPLICATOR,1624486,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SIMETHICONE (MYLICON) 80MG CHEWABLE TAB,1624504,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARBIDOPA/LEVODOPA(SINEMET) 10/100MG TAB,1624509,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARBIDOPA/LEVADOPA(SINEMET)CR 25/100MG,1624530,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IRON SLOW RELEASE TABLET,1624607,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM BICARBONATE 50 MEQ/50ML vial,1624767,CDM,250,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
SODIUM BICARB 8.4% PFS 50 MEQ/50ML,1624768,CDM,250,RC,,,outpatient,,,31.23,15.62,,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.99,38.4,,9.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.99,38.4,,9.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.93,35,,8.744,percent of total billed charges,35% of total billed charges for outpatient setting,24.36,78,,19.488,percent of total billed charges,78% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,21.86,70,,17.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,75,,18.736,percent of total billed charges,75% of total billed charges for outpatient setting,25.92,83,,20.736,percent of total billed charges,83% of total billed charges for outpatient setting,15.62,50,,12.496,percent of total billed charges,50% of total billed charges for outpatient setting,15.62,50,,12.496,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.23,39.17,,9.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.93,25.92,
SODIUM BICARB 4.2% PEDIAT 10ML 5MEQ/10ML,1624769,CDM,250,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
SODIUM BICARBONATE 650 MG TABLET,1624879,CDM,637,RC,,,outpatient,,,3.5,1.75,,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.34,38.4,,1.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.34,38.4,,1.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.63,75,,2.104,percent of total billed charges,75% of total billed charges for outpatient setting,2.63,75,,2.104,percent of total billed charges,75% of total billed charges for outpatient setting,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.63,75,,2.104,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.23,35,,0.984,percent of total billed charges,35% of total billed charges for outpatient setting,2.73,78,,2.184,percent of total billed charges,78% of total billed charges for outpatient setting,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,2.45,70,,1.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.63,75,,2.104,percent of total billed charges,75% of total billed charges for outpatient setting,2.91,83,,2.328,percent of total billed charges,83% of total billed charges for outpatient setting,1.75,50,,1.4,percent of total billed charges,50% of total billed charges for outpatient setting,1.75,50,,1.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.37,39.17,,1.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.23,2.91,
SODIUM BICARBONATE 650 MG TABLET,1624880,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM CHLORIDE 0.9%  10ML VIAL,1624913,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM POLYSTYRENE (SPS) 15G/60ML SUSP,1624916,CDM,637,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
SODIUM PHOSPHATES 15 MMOL / 5 ML,1624923,CDM,250,RC,,,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
HYDROCORTISONE (SOLU-CORTEF) 100 MG vial,1624966,CDM,636,RC,J1720,HCPCS,both,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.85,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,39.01,
METHYLPREDNISOLONE(SOLU-MEDROL)125MG/2ML,1624975,CDM,636,RC,J2930,HCPCS,both,,,23.63,11.82,,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.43,78,,14.744,percent of total billed charges,78% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,16.54,70,,13.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.72,75,,14.176,percent of total billed charges,75% of total billed charges for outpatient setting,19.61,83,,15.688,percent of total billed charges,83% of total billed charges for outpatient setting,11.82,50,,9.456,percent of total billed charges,50% of total billed charges for outpatient setting,11.82,50,,9.456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,19.61,
METHYLPREDNISOLONE(SOLU-MEDROL) 1000 mg,1624976,CDM,250,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
SORBITOL 70% SOLUTION 60ML /1ML,1624993,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SPIRONOLACTONE (ALDACTONE) 25 MG TABLET,1625073,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUTORPHANOL (STADOL) 2MG vial,1625117,CDM,636,RC,J0595,HCPCS,both,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.94,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,14.11,
STERILE WATER 10ML VIAL,1625194,CDM,260,RC,A4216,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,212,
"WATER FOR INJECTION,STERILE 1000ML",1625227,CDM,250,RC,,,outpatient,,,15.19,7.6,,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.32,35,,4.256,percent of total billed charges,35% of total billed charges for outpatient setting,11.85,78,,9.48,percent of total billed charges,78% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,12.61,83,,10.088,percent of total billed charges,83% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,39.17,,4.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.32,12.61,
"WATER FOR IRRIGATION,STERILE 1000ML",1625228,CDM,250,RC,,,outpatient,,,12.6,6.3,,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.41,35,,3.528,percent of total billed charges,35% of total billed charges for outpatient setting,9.83,78,,7.864,percent of total billed charges,78% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,10.46,83,,8.368,percent of total billed charges,83% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.94,39.17,,3.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.41,10.46,
SUCCINYLCHOLINE (ANECTINE) 20 MG/ML vial,1625233,CDM,250,RC,J0330,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
SUFENTANIL (SUFENTA) 100 MCG/2ML AMP,1625244,CDM,250,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
LEVOTHYROXINE (SYNTHROID) 112 MCG TABLET,1625493,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 125 MCG TABLET,1625494,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 100 MCG TABLET,1625517,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 150 MCG TABLET,1625524,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 25 MCG TABLET,1625533,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 50 MCG TABLET,1625538,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOTHYROXINE (SYNTHROID) 75 MCG TABLET,1625540,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
"PACLITAXEL,SEMI-SYNTH(TAXOL) 6MG/1ML VL",1625617,CDM,636,RC,J9265,HCPCS,both,,,4713,2356.5,,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1809.79,38.4,,1447.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1809.79,38.4,,1447.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1649.55,35,,1319.64,percent of total billed charges,35% of total billed charges for outpatient setting,3676.14,78,,2940.912,percent of total billed charges,78% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3911.79,83,,3129.432,percent of total billed charges,83% of total billed charges for outpatient setting,2356.5,50,,1885.2,percent of total billed charges,50% of total billed charges for outpatient setting,2356.5,50,,1885.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1845.99,39.17,,1476.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1649.55,3911.79,
CEFTAZIDIME (FORTAZ) 1 GRAM VIAL,1625628,CDM,250,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
CARBAMAZEPINE (TEGRETOL) 200 MG TABLET,1625648,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TEMAZEPAM (RESTORIL) 15 MG capsule,1625687,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TETRACAINE 0.5% OPHTH SOLN BOTTLE,1625913,CDM,637,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
SILVER SULFADIAZINE (SILVADINE),1626253,CDM,637,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
MULTI-VITAMIN (THERAGRAN) TABLET,1626279,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MULTI-VITAMIN W/ MIN (THERAGRAN-M) TAB,1626280,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VITAMIN B-1 (THIAMINE) 200 MG / 2ML vial,1626286,CDM,250,RC,,,outpatient,,,16.88,8.44,,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.48,38.4,,5.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.48,38.4,,5.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.91,35,,4.728,percent of total billed charges,35% of total billed charges for outpatient setting,13.17,78,,10.536,percent of total billed charges,78% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,14.01,83,,11.208,percent of total billed charges,83% of total billed charges for outpatient setting,8.44,50,,6.752,percent of total billed charges,50% of total billed charges for outpatient setting,8.44,50,,6.752,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.61,39.17,,5.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.91,14.01,
THIAMINE (VITAMIN B-1) 100 MG TABLET,1626288,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
Timolol maleate (TIMOPTIC) 0.5% drops,1626685,CDM,637,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
TOBRAMYCIN OPTH SOL BOTTLE,1626723,CDM,637,RC,,,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,45.65,
Tobramycin/dexamethasone (TOBRADEX) BTL,1626726,CDM,637,RC,,,outpatient,,,279,139.5,,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.14,38.4,,85.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.14,38.4,,85.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.65,35,,78.12,percent of total billed charges,35% of total billed charges for outpatient setting,217.62,78,,174.096,percent of total billed charges,78% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,195.3,70,,156.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,209.25,75,,167.4,percent of total billed charges,75% of total billed charges for outpatient setting,231.57,83,,185.256,percent of total billed charges,83% of total billed charges for outpatient setting,139.5,50,,111.6,percent of total billed charges,50% of total billed charges for outpatient setting,139.5,50,,111.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.28,39.17,,87.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,97.65,231.57,
METOPROLOL SUCC (TOPROL XL) 50 MG TAB,1626951,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KETOROLAC (TORADOL) 30 MG vial,1626957,CDM,636,RC,J1885,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,4.15,
ALTEPLASE (ACTIVASE) 100 MG vial,1626984,CDM,636,RC,J2997,HCPCS,both,,,31803,15901.5,,22262.1,70,,17809.68,percent of total billed charges,70% of total billed charges for outpatient setting,88.97,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12212.35,38.4,,9769.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12212.35,38.4,,9769.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,39.65,100,,,case rate,100% Anthem TPA case rate for outpatient setting,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11131.05,35,,8904.84,percent of total billed charges,35% of total billed charges for outpatient setting,24806.34,78,,19845.072,percent of total billed charges,78% of total billed charges for outpatient setting,22262.1,70,,17809.68,percent of total billed charges,70% of total billed charges for outpatient setting,22262.1,70,,17809.68,percent of total billed charges,70% of total billed charges for outpatient setting,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23852.25,75,,19081.8,percent of total billed charges,75% of total billed charges for outpatient setting,26396.49,83,,21117.192,percent of total billed charges,83% of total billed charges for outpatient setting,15901.5,50,,12721.2,percent of total billed charges,50% of total billed charges for outpatient setting,15901.5,50,,12721.2,percent of total billed charges,50% of total billed charges for outpatient setting,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12456.6,39.17,,9965.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,88.97,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.65,26396.49,
ELECTROLYTE SOLUTION 20ML,1626992,CDM,250,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
ATRACURIUM (TRACRIUM) 100MG / 10ML vial,1626993,CDM,250,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
NITROGLYCERIN (NITRO-DUR) 0.2 MG patch,1627005,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TRAZODONE (DESYREL) 50 MG TABLET,1627168,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PENTOXIFYLLINE ER (TRENTAL) 400 MG TAB,1627173,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TRIAMCINOLONE 0.1% 15 Grams cream,1627472,CDM,637,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
TRIAMCINOLONE ACETONIDE 0.1% OINT 80GM,1627473,CDM,637,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
DORZOLAMIDE HCL (TRUSOPT) 2% EYE DROPS,1627835,CDM,637,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
WITCH HAZEL (TUCKS) 40 PAD PACK,1627849,CDM,637,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
TRAMADOL (ULTRAM) 50 MG TABLET,1627934,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMPICILLIN/SULBACTAM (UNASYN) 1.5 GM vl,1627939,CDM,250,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
AMPICILLIN/SULBACTAM (UNASYN) 3 GM vial,1627941,CDM,250,RC,,,outpatient,,,43.04,21.52,,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.53,38.4,,13.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.53,38.4,,13.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,32.28,75,,25.824,percent of total billed charges,75% of total billed charges for outpatient setting,32.28,75,,25.824,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,32.28,75,,25.824,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.06,35,,12.048,percent of total billed charges,35% of total billed charges for outpatient setting,33.57,78,,26.856,percent of total billed charges,78% of total billed charges for outpatient setting,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,70,,24.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.28,75,,25.824,percent of total billed charges,75% of total billed charges for outpatient setting,35.72,83,,28.576,percent of total billed charges,83% of total billed charges for outpatient setting,21.52,50,,17.216,percent of total billed charges,50% of total billed charges for outpatient setting,21.52,50,,17.216,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.86,39.17,,13.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.06,35.72,
VALACYCLOVIR (VALTREX) 500 MG TABLET,1628167,CDM,637,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
VANCOMYCIN 1000 MG VIAL INJ,1628185,CDM,636,RC,J3370,HCPCS,both,,,10.13,5.07,,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.43,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.9,78,,6.32,percent of total billed charges,78% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,8.41,83,,6.728,percent of total billed charges,83% of total billed charges for outpatient setting,5.07,50,,4.056,percent of total billed charges,50% of total billed charges for outpatient setting,5.07,50,,4.056,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.31,8.41,
VANCOMYCIN 500 MG VIAL INJ,1628193,CDM,250,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
VANCOMYCIN HCL (VANCOCIN) 250MG/5ML SOLN,1628198,CDM,250,RC,,,outpatient,,,130.3,65.15,,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.04,38.4,,40.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.04,38.4,,40.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,97.73,75,,78.184,percent of total billed charges,75% of total billed charges for outpatient setting,97.73,75,,78.184,percent of total billed charges,75% of total billed charges for outpatient setting,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,97.73,75,,78.184,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.61,35,,36.488,percent of total billed charges,35% of total billed charges for outpatient setting,101.63,78,,81.304,percent of total billed charges,78% of total billed charges for outpatient setting,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,91.21,70,,72.968,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.73,75,,78.184,percent of total billed charges,75% of total billed charges for outpatient setting,108.15,83,,86.52,percent of total billed charges,83% of total billed charges for outpatient setting,65.15,50,,52.12,percent of total billed charges,50% of total billed charges for outpatient setting,65.15,50,,52.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.04,39.17,,40.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.61,108.15,
ENALAPRIL (VASOTEC) 5 MG TABLET,1628236,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ENALAPRIL (VASOTEC) 1.25 MG vial,1628245,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PITRESSIN (VASOPRESSIN) 20 UNITS vial,1628248,CDM,250,RC,,,outpatient,,,507,253.5,,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.69,38.4,,155.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.69,38.4,,155.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,380.25,75,,304.2,percent of total billed charges,75% of total billed charges for outpatient setting,380.25,75,,304.2,percent of total billed charges,75% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,380.25,75,,304.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177.45,35,,141.96,percent of total billed charges,35% of total billed charges for outpatient setting,395.46,78,,316.368,percent of total billed charges,78% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,354.9,70,,283.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,380.25,75,,304.2,percent of total billed charges,75% of total billed charges for outpatient setting,420.81,83,,336.648,percent of total billed charges,83% of total billed charges for outpatient setting,253.5,50,,202.8,percent of total billed charges,50% of total billed charges for outpatient setting,253.5,50,,202.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,198.58,39.17,,158.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,177.45,420.81,
VERAPAMIL ER (CALAN SR) 180 MG TABLET,1628372,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
VERAPAMIL (CALAN) 80 MG TABLET,1628437,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VERAPAMIL HCL (CALAN) 5MG/2ML,1628483,CDM,250,RC,,,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,46.48,
VERAPAMIL SR (CALAN SR) 120 MG TABLET,1628484,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
MIDAZOLAM (VERSED) 2 MG vial,1628490,CDM,636,RC,J2250,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,4.15,
MIDAZOLAM (VERSED) 50 MG vial,1628492,CDM,636,RC,J2250,HCPCS,both,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,21.58,
MIDAZOLAM (VERSED) 5 MG VIAL,1628493,CDM,636,RC,J2250,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,4.15,
VITAMIN E 400 IU capsule,1628603,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ASCORBIC ACID (VITAMIN C) 500 MG TABLET,1628707,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHYTONADIONE (VIT K) 10 MG AMP,1628804,CDM,250,RC,,,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.05,135.29,
BUPROPION SR (WELLBUTRIN SR) 100 MG TAB,1628849,CDM,637,RC,,,outpatient,,,12.66,6.33,,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.86,38.4,,3.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.86,38.4,,3.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,35,,3.544,percent of total billed charges,35% of total billed charges for outpatient setting,9.87,78,,7.896,percent of total billed charges,78% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,10.51,83,,8.408,percent of total billed charges,83% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.96,39.17,,3.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.43,10.51,
LIDOCAINE 2%/EPINEPH (XYLOCAINE) 20ML VL,1628928,CDM,250,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
LIDOCAINE 2%/EPINEPH (XYLOCAINE) 20ML VL,1628929,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
LIDOCAINE HCL (XYLOCAINE) 250MG/50ML VL,1628956,CDM,250,RC,,,outpatient,,,19.4,9.7,,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,75,,11.64,percent of total billed charges,75% of total billed charges for outpatient setting,14.55,75,,11.64,percent of total billed charges,75% of total billed charges for outpatient setting,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,14.55,75,,11.64,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.79,35,,5.432,percent of total billed charges,35% of total billed charges for outpatient setting,15.13,78,,12.104,percent of total billed charges,78% of total billed charges for outpatient setting,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,13.58,70,,10.864,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.55,75,,11.64,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,83,,12.88,percent of total billed charges,83% of total billed charges for outpatient setting,9.7,50,,7.76,percent of total billed charges,50% of total billed charges for outpatient setting,9.7,50,,7.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.6,39.17,,6.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.79,16.1,
LIDOCAINE/EPINEPH (XYLOCAINE) 50ML VL,1628961,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
LIDOCAINE/EPINEP (XYLOCAINE) 50ML VL,1628962,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
LIDOCAINE HCL 100MG/5ML PFS,1628979,CDM,250,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
RANITIDINE (ZANTAC) 150 MG TABLET,1629018,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
RANITIDINE (ZANTAC) 50 MG vial,1629032,CDM,250,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
METOLAZONE (ZAROXYOLYN) 2.5 MG TABLET,1629038,CDM,637,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
BISOPROLOL (ZEBETA) 5 MG TABLET,1629047,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ROCURONIUM (ZEMURON) 50mg/5ml VIAL,1629053,CDM,250,RC,,,outpatient,,,11.2,5.6,,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,38.4,,3.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.3,38.4,,3.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,35,,3.136,percent of total billed charges,35% of total billed charges for outpatient setting,8.74,78,,6.992,percent of total billed charges,78% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,83,,7.44,percent of total billed charges,83% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.39,39.17,,3.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.92,9.3,
LISINOPRIL (PRINVIL/ZESTRIL) 20MG TABLET,1629067,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BISOPROLOL/HCTZ 10/6.5 MG TABLET,1629088,CDM,637,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BISOPROLOL / HCTZ 5/6.25MG TABLET,1629090,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ZINC 220 MG capsule,1629107,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ZINC OXIDE 60GM TUBE,1629141,CDM,637,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
AZITHROMYCIN (ZITHROMAX) 600MG/15ML BTL,1629149,CDM,637,RC,,,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,36.52,
AZITHROMYCIN (ZITHROMAX) 250 MG TABLET,1629152,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SIMVASTATIN (ZOCOR) 10 MG TABLET,1629155,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SIMVASTATIN (ZOCOR) 40 MG TABLET,1629161,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ONDANSETRON (ZOFRAN) 4 MG vial,1629171,CDM,636,RC,J2405,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.11,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,4.15,
SERTRALINE (ZOLOFT) 100 MG TABLET,1629175,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACYCLOVIR (ZOVIRAX) 400 MG TABLET,1629192,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACYCLOVIR (ZOVIRAX) 500 MG VL,1629196,CDM,636,RC,J0133,HCPCS,both,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.06,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.06,9.13,
BUPIVACAINE(SENSORCAINE)/EPIN 0.5% 50ML,1630000,CDM,250,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
MORPHINE SULF/PF(MORPHINE PCA) 30MG/30ML,1630006,CDM,636,RC,J2275,HCPCS,both,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
ALBUMIN (HUMAN) 25% 12.5GM/50ML IV,1630021,CDM,250,RC,,,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.15,35,,41.72,percent of total billed charges,35% of total billed charges for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.36,39.17,,46.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.15,123.67,
"HEPARIN PREMIX 25,000 UNITS/500ML IV BAG",1630031,CDM,250,RC,,,outpatient,,,10.13,5.07,,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.89,38.4,,3.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.89,38.4,,3.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.55,35,,2.84,percent of total billed charges,35% of total billed charges for outpatient setting,7.9,78,,6.32,percent of total billed charges,78% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,7.09,70,,5.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.6,75,,6.08,percent of total billed charges,75% of total billed charges for outpatient setting,8.41,83,,6.728,percent of total billed charges,83% of total billed charges for outpatient setting,5.07,50,,4.056,percent of total billed charges,50% of total billed charges for outpatient setting,5.07,50,,4.056,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.97,39.17,,3.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.55,8.41,
LAMIVUDINE (EPIVIR) 150MG TABLET,1630045,CDM,637,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
ATORVASTATIN (LIPITOR) 10 MG TABLET,1630055,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LATANOPROST (XALATAN) 0.005% /2.5ML GTTS,1630078,CDM,637,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
NITROPRUSSIDE (NITROPRESS) 50MG/2ml vial,1630086,CDM,637,RC,,,outpatient,,,372,186,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.85,38.4,,114.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.85,38.4,,114.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.2,35,,104.16,percent of total billed charges,35% of total billed charges for outpatient setting,290.16,78,,232.128,percent of total billed charges,78% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.76,83,,247.008,percent of total billed charges,83% of total billed charges for outpatient setting,186,50,,148.8,percent of total billed charges,50% of total billed charges for outpatient setting,186,50,,148.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.71,39.17,,116.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,130.2,308.76,
GLIMEPIRIDE (AMARYL) 2 MG TABLET,1630088,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LIDOCAINE HCL (XYLOCAINE) 2% AMP 10ML,1630095,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
CALCIUM ACETATE (PHOSLO) 667 MG TAB,1630097,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LIDOCAINE 1% 200mg/20mL vial,1630100,CDM,250,RC,,,outpatient,,,8.4,4.2,,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.23,38.4,,2.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.23,38.4,,2.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.94,35,,2.352,percent of total billed charges,35% of total billed charges for outpatient setting,6.55,78,,5.24,percent of total billed charges,78% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,5.88,70,,4.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,75,,5.04,percent of total billed charges,75% of total billed charges for outpatient setting,6.97,83,,5.576,percent of total billed charges,83% of total billed charges for outpatient setting,4.2,50,,3.36,percent of total billed charges,50% of total billed charges for outpatient setting,4.2,50,,3.36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.29,39.17,,2.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.94,6.97,
LIDOCAINE 2% 400MG/20ML vial,1630101,CDM,250,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
DONEPEZIL (ARICEPT) 5 MG TABLET,1630107,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMOXICILLIN/CLAV(AUGMENTIN) 875 MG TAB,1630115,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OLANZAPINE (ZYPREXA) 5 MG TABLET,1630117,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AZITHROMYCIN (ZITHROMAX) 500MG VIAL,1630118,CDM,636,RC,J0456,HCPCS,both,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
BUPROPION SR (WELLBUTRIN SR) 150MG TAB,1630130,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TAMSULOSIN (FLOMAX) 0.4 MG capsule,1630147,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOFLOXACIN (LEVAQUIN) 500 MG TABLET,1630152,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARVEDILOL (COREG) 3.125 MG TABLET,1630157,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IPRATROPIUM (ATROVENT) 0.5MG/2.5ML,1630160,CDM,637,RC,J7644,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM CHLORIDE INHALATION 3 ml,1630163,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ENOXAPARIN (LOVENOX) 40 MG syringe,1630171,CDM,636,RC,J1650,HCPCS,both,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
CLOPIDOGREL (PLAVIX) 75 MG TABLET,1630179,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
COLLAGENASE (SANTYL) OINTMENT,1630181,CDM,637,RC,,,outpatient,,,686,343,,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.42,38.4,,210.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,263.42,38.4,,210.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,514.5,75,,411.6,percent of total billed charges,75% of total billed charges for outpatient setting,514.5,75,,411.6,percent of total billed charges,75% of total billed charges for outpatient setting,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,514.5,75,,411.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240.1,35,,192.08,percent of total billed charges,35% of total billed charges for outpatient setting,535.08,78,,428.064,percent of total billed charges,78% of total billed charges for outpatient setting,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,480.2,70,,384.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,514.5,75,,411.6,percent of total billed charges,75% of total billed charges for outpatient setting,569.38,83,,455.504,percent of total billed charges,83% of total billed charges for outpatient setting,343,50,,274.4,percent of total billed charges,50% of total billed charges for outpatient setting,343,50,,274.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.69,39.17,,214.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,240.1,569.38,
QUETIAPINE (SEROQUEL) 100 MG TAB,1630187,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MONTELUKAST (SINGULAIR) 10 MG TABLET,1630188,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GAUZE BANDAGE (NU-GAUZE) 40X5 YDS,1630202,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
GAUZE BANDAGE (NU-GAUZE) 20X5 YDS,1630203,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
GAUZE BANDAGE (NU-GAUZE)STRIPS 20X5 YDS,1630205,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
CITALOPRAM (CELEXA) 20 MG TABLET,1630206,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
RALOXIFENE (EVISTA) 60 MG TABLET,1630222,CDM,637,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
CARVEDILOL (COREG) 25 MG TABLET,1630225,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
Mirtazapine (REMERON) 30 MG TABLET,1630229,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ENOXAPARIN (LOVENOX) 100 MG/1ML SYR,1630234,CDM,636,RC,J1650,HCPCS,both,,,27.85,13.93,,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.69,38.4,,8.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.69,38.4,,8.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,20.89,75,,16.712,percent of total billed charges,75% of total billed charges for outpatient setting,20.89,75,,16.712,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,20.89,75,,16.712,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,35,,7.8,percent of total billed charges,35% of total billed charges for outpatient setting,21.72,78,,17.376,percent of total billed charges,78% of total billed charges for outpatient setting,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,70,,15.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.89,75,,16.712,percent of total billed charges,75% of total billed charges for outpatient setting,23.12,83,,18.496,percent of total billed charges,83% of total billed charges for outpatient setting,13.93,50,,11.144,percent of total billed charges,50% of total billed charges for outpatient setting,13.93,50,,11.144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.9,39.17,,8.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.75,23.12,
DORZOLAMIDE/TIMOLOL (COSOPT) OPTH drops,1630247,CDM,637,RC,,,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.75,35,,51.8,percent of total billed charges,35% of total billed charges for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.46,39.17,,57.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.75,153.55,
LEVOFLOXACIN/D5W(LEVAQUIN)500MG/100ML IV,1630263,CDM,250,RC,,,outpatient,,,6.75,3.38,,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.59,38.4,,2.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.36,35,,1.888,percent of total billed charges,35% of total billed charges for outpatient setting,5.27,78,,4.216,percent of total billed charges,78% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,4.73,70,,3.784,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.06,75,,4.048,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,83,,4.48,percent of total billed charges,83% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,3.38,50,,2.704,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.64,39.17,,2.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.36,5.6,
POLYETHYLENE GLYCOL (MIRALAX) 17 Gr PACK,1630273,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PIOGLITAZONE (ACTOS) 30 MG TABLET,1630279,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOFLOXACIN (LEVAQUIN) IN D5W 250MG BAG,1630283,CDM,250,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
OXYCODONE ER (OXYCONTIN) 10 MG TABLET,1630285,CDM,637,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
PROPOFOL (DIPRIVAN) 10 MG/ML 100 ML BTL,1630288,CDM,250,RC,J3490,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
HYDROCODONE / APAP (NORCO) 10/325 MG TAB,1630400,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OXYCODONE ER (OXYCONTIN) 20 MG TABLET,1630896,CDM,637,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
BUDESONIDE (PULMICORT) 0.25MG/2ML,1630906,CDM,250,RC,,,outpatient,,,30.8,15.4,,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.83,38.4,,9.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.83,38.4,,9.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.78,35,,8.624,percent of total billed charges,35% of total billed charges for outpatient setting,24.02,78,,19.216,percent of total billed charges,78% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,25.56,83,,20.448,percent of total billed charges,83% of total billed charges for outpatient setting,15.4,50,,12.32,percent of total billed charges,50% of total billed charges for outpatient setting,15.4,50,,12.32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.07,39.17,,9.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.78,25.56,
PANTOPRAZOLE(PROTONIX)IV/NS10ML 40MG INJ,1630911,CDM,250,RC,,,outpatient,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
TOLTERODINE TART(DETROL LA) 2MG CAP,1630916,CDM,250,RC,,,outpatient,,,36.4,18.2,,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.98,38.4,,11.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.98,38.4,,11.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,75,,21.84,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,75,,21.84,percent of total billed charges,75% of total billed charges for outpatient setting,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,75,,21.84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.74,35,,10.192,percent of total billed charges,35% of total billed charges for outpatient setting,28.39,78,,22.712,percent of total billed charges,78% of total billed charges for outpatient setting,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,25.48,70,,20.384,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,75,,21.84,percent of total billed charges,75% of total billed charges for outpatient setting,30.21,83,,24.168,percent of total billed charges,83% of total billed charges for outpatient setting,18.2,50,,14.56,percent of total billed charges,50% of total billed charges for outpatient setting,18.2,50,,14.56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.26,39.17,,11.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.74,30.21,
AMMONIUM LACTATE (AMLACTIN) 12% LOTION,1630920,CDM,637,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
ISOSORBIDE MONONIT ER (IMDUR) 30 MG TAB,1630926,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUDESONIDE (PULMICORT) 0.5MG/2ML RESPULE,1630930,CDM,637,RC,,,outpatient,,,53.2,26.6,,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.43,38.4,,16.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.43,38.4,,16.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.62,35,,14.896,percent of total billed charges,35% of total billed charges for outpatient setting,41.5,78,,33.2,percent of total billed charges,78% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,37.24,70,,29.792,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.9,75,,31.92,percent of total billed charges,75% of total billed charges for outpatient setting,44.16,83,,35.328,percent of total billed charges,83% of total billed charges for outpatient setting,26.6,50,,21.28,percent of total billed charges,50% of total billed charges for outpatient setting,26.6,50,,21.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.84,39.17,,16.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.62,44.16,
ATORVASTATIN (LIPITOR) 20 MG TABLET,1630941,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TENECTEPLASE (TNKASE) 50 MG KIT,1630949,CDM,636,RC,J3101,HCPCS,both,,,21184,10592,,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,153.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,8134.66,38.4,,6507.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8134.66,38.4,,6507.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,15888,75,,12710.4,percent of total billed charges,75% of total billed charges for outpatient setting,15888,75,,12710.4,percent of total billed charges,75% of total billed charges for outpatient setting,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,15888,75,,12710.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7414.4,35,,5931.52,percent of total billed charges,35% of total billed charges for outpatient setting,16523.52,78,,13218.816,percent of total billed charges,78% of total billed charges for outpatient setting,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,14828.8,70,,11863.04,percent of total billed charges,70% of total billed charges for outpatient setting,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15888,75,,12710.4,percent of total billed charges,75% of total billed charges for outpatient setting,17582.72,83,,14066.176,percent of total billed charges,83% of total billed charges for outpatient setting,10592,50,,8473.6,percent of total billed charges,50% of total billed charges for outpatient setting,10592,50,,8473.6,percent of total billed charges,50% of total billed charges for outpatient setting,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8297.35,39.17,,6637.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,153.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.11,17582.72,
POTASSIUM CHLORIDE 20MEQ/15ML,1630953,CDM,258,RC,,,outpatient,,,0.85,0.43,,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,38.4,,0.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.33,38.4,,0.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,0.64,75,,0.512,percent of total billed charges,75% of total billed charges for outpatient setting,0.64,75,,0.512,percent of total billed charges,75% of total billed charges for outpatient setting,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,0.64,75,,0.512,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.3,35,,0.24,percent of total billed charges,35% of total billed charges for outpatient setting,0.66,78,,0.528,percent of total billed charges,78% of total billed charges for outpatient setting,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,0.6,70,,0.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.64,75,,0.512,percent of total billed charges,75% of total billed charges for outpatient setting,0.71,83,,0.568,percent of total billed charges,83% of total billed charges for outpatient setting,0.43,50,,0.344,percent of total billed charges,50% of total billed charges for outpatient setting,0.43,50,,0.344,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.34,39.17,,0.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.3,0.71,
POTASSIUM CHLORIDE 40 MEQ/100ML BAG,1630954,CDM,258,RC,,,outpatient,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
POTASSIUM CL 20 MEQ/100 ML SW 100ML BAG,1630955,CDM,258,RC,,,outpatient,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
TOPIRAMATE (TOPAMAX) 25 MG TABLET,1630974,CDM,637,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
ENOXAPARIN (LOVENOX) 60 MG syringe,1630987,CDM,636,RC,J1650,HCPCS,both,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
LISINOPRIL (PRINVIL/ZESTRIL) 40MG TAB,1634493,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVALBUTEROL (XOPENEX) 0.63MG/3ML SOLN,1634495,CDM,637,RC,,,outpatient,,,5.06,2.53,,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.94,38.4,,1.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.77,35,,1.416,percent of total billed charges,35% of total billed charges for outpatient setting,3.95,78,,3.16,percent of total billed charges,78% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,3.54,70,,2.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.8,75,,3.04,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,83,,3.36,percent of total billed charges,83% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,2.53,50,,2.024,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.98,39.17,,1.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.77,4.2,
PROPOFOL (DIPRIVAN) 200 MG vial,1634499,CDM,250,RC,,,outpatient,,,12.6,6.3,,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.84,38.4,,3.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.41,35,,3.528,percent of total billed charges,35% of total billed charges for outpatient setting,9.83,78,,7.864,percent of total billed charges,78% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,8.82,70,,7.056,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,75,,7.56,percent of total billed charges,75% of total billed charges for outpatient setting,10.46,83,,8.368,percent of total billed charges,83% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,6.3,50,,5.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.94,39.17,,3.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.41,10.46,
TRIAMCINOLONE 0.1% CREAM 80GM,1634513,CDM,637,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
CLOBETASOL PROP(TEMOVATE) 0.05% CREAM,1634518,CDM,637,RC,,,outpatient,,,461,230.5,,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177.02,38.4,,141.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.02,38.4,,141.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,345.75,75,,276.6,percent of total billed charges,75% of total billed charges for outpatient setting,345.75,75,,276.6,percent of total billed charges,75% of total billed charges for outpatient setting,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,345.75,75,,276.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.35,35,,129.08,percent of total billed charges,35% of total billed charges for outpatient setting,359.58,78,,287.664,percent of total billed charges,78% of total billed charges for outpatient setting,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,322.7,70,,258.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,345.75,75,,276.6,percent of total billed charges,75% of total billed charges for outpatient setting,382.63,83,,306.104,percent of total billed charges,83% of total billed charges for outpatient setting,230.5,50,,184.4,percent of total billed charges,50% of total billed charges for outpatient setting,230.5,50,,184.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.56,39.17,,144.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,161.35,382.63,
LACRI-LUBE EYE OINT 3.5GM,1634519,CDM,637,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
PANTOPRAZOLE (PROTONIX) 40 MG TABLET,1634520,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVOFLOXACIN (LEVAQUIN) 750MG/150ML IVPB,1634521,CDM,250,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
BUMETANIDE (BUMEX) 2.5MG/10ML,1634524,CDM,637,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
BUPIVACAINE/EPI(SENSORCAINE)0.5% 30ML VL,1634527,CDM,250,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BUPROPRION (WELLBUTRIN) 75 MG TABLET,1634536,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GLUCOSE ORAL GEL TUBE,1634551,CDM,637,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
KETAMINE (KETALAR) 500 MG vial,1634555,CDM,250,RC,,,outpatient,,,51.8,25.9,,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.89,38.4,,15.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.89,38.4,,15.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.13,35,,14.504,percent of total billed charges,35% of total billed charges for outpatient setting,40.4,78,,32.32,percent of total billed charges,78% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,36.26,70,,29.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.85,75,,31.08,percent of total billed charges,75% of total billed charges for outpatient setting,42.99,83,,34.392,percent of total billed charges,83% of total billed charges for outpatient setting,25.9,50,,20.72,percent of total billed charges,50% of total billed charges for outpatient setting,25.9,50,,20.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.29,39.17,,16.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.13,42.99,
BUPIVACAINE/EPI(MARCAINE) 0.25% 50ML,1634559,CDM,250,RC,,,outpatient,,,44.8,22.4,,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.68,35,,12.544,percent of total billed charges,35% of total billed charges for outpatient setting,34.94,78,,27.952,percent of total billed charges,78% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,37.18,83,,29.744,percent of total billed charges,83% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.54,39.17,,14.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.68,37.18,
CEFEPIME (MAXIPIME) 1 GRAM vial,1634560,CDM,250,RC,J0692,HCPCS,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
SODIUM CHLORIDE 0.9% 50ML MINIBAG IV,1634570,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
NORMAL SALINE 100ML + ADAPTER,1634571,CDM,258,RC,,,outpatient,,,9.28,4.64,,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.56,38.4,,2.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.25,35,,2.6,percent of total billed charges,35% of total billed charges for outpatient setting,7.24,78,,5.792,percent of total billed charges,78% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,6.5,70,,5.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.96,75,,5.568,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,83,,6.16,percent of total billed charges,83% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,4.64,50,,3.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.63,39.17,,2.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.25,7.7,
SULFACETAMIDE 10% (BLEPH-10) OPHTH SOLN,1634573,CDM,637,RC,,,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,35,,37.8,percent of total billed charges,35% of total billed charges for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.88,39.17,,42.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.25,112.05,
TRIAMTERENE & HCTZ (MAXZIDE) 37.5/25 MG,1634577,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METFORMIN (GLUCOPHAGE) 500 MG TABLET,1634580,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NIACIN ER (NIASPAN) 500MG TABLET,1634587,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PENICILLIN (PEN-V-K) 500 MG TABLET,1634589,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BEER CAN,1634595,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
GAUZE BANDAGE (NU-GAUZE STRIPS) 1 X5YDS,1634610,CDM,270,RC,,,outpatient,,,14.15,7.08,,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.43,38.4,,4.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.43,38.4,,4.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,10.61,75,,8.488,percent of total billed charges,75% of total billed charges for outpatient setting,10.61,75,,8.488,percent of total billed charges,75% of total billed charges for outpatient setting,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,10.61,75,,8.488,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.95,35,,3.96,percent of total billed charges,35% of total billed charges for outpatient setting,11.04,78,,8.832,percent of total billed charges,78% of total billed charges for outpatient setting,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,9.91,70,,7.928,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.61,75,,8.488,percent of total billed charges,75% of total billed charges for outpatient setting,11.74,83,,9.392,percent of total billed charges,83% of total billed charges for outpatient setting,7.08,50,,5.664,percent of total billed charges,50% of total billed charges for outpatient setting,7.08,50,,5.664,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.54,39.17,,4.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.95,11.74,
PNEUMOC VAC 23 (PNEUMOVAX) 25MCG/0.5ML,1634619,CDM,636,RC,90732,HCPCS,both,,,298,149,,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,133.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,140.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,232.44,78,,185.952,percent of total billed charges,78% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,247.34,83,,197.872,percent of total billed charges,83% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.47,247.34,
MORPHINE  4 MG/1ML INJECTION,1634622,CDM,636,RC,J2270,HCPCS,both,,,9.8,4.9,,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.64,78,,6.112,percent of total billed charges,78% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,83,,6.504,percent of total billed charges,83% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,8.13,
ESCITALOPRAM (LEXAPRO) 10 MG TABLET,1634638,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HUMULIN R INSULIN,1634640,CDM,637,RC,J1815,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,4.15,
PACLITAXEL (TAXOL) 6MG/1ML VIAL,1634660,CDM,636,RC,J9265,HCPCS,both,,,5320,2660,,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2042.88,38.4,,1634.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2042.88,38.4,,1634.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,3990,75,,3192,percent of total billed charges,75% of total billed charges for outpatient setting,3990,75,,3192,percent of total billed charges,75% of total billed charges for outpatient setting,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,3990,75,,3192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1862,35,,1489.6,percent of total billed charges,35% of total billed charges for outpatient setting,4149.6,78,,3319.68,percent of total billed charges,78% of total billed charges for outpatient setting,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,3724,70,,2979.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3990,75,,3192,percent of total billed charges,75% of total billed charges for outpatient setting,4415.6,83,,3532.48,percent of total billed charges,83% of total billed charges for outpatient setting,2660,50,,2128,percent of total billed charges,50% of total billed charges for outpatient setting,2660,50,,2128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2083.74,39.17,,1666.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1862,4415.6,
THIOSULF/NIT/AMYL NIT (CYANIDE ANTIDOTE),1634667,CDM,250,RC,,,outpatient,,,661.7,330.85,,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,254.09,38.4,,203.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,254.09,38.4,,203.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,496.28,75,,397.024,percent of total billed charges,75% of total billed charges for outpatient setting,496.28,75,,397.024,percent of total billed charges,75% of total billed charges for outpatient setting,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,496.28,75,,397.024,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231.6,35,,185.28,percent of total billed charges,35% of total billed charges for outpatient setting,516.13,78,,412.904,percent of total billed charges,78% of total billed charges for outpatient setting,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,463.19,70,,370.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,496.28,75,,397.024,percent of total billed charges,75% of total billed charges for outpatient setting,549.21,83,,439.368,percent of total billed charges,83% of total billed charges for outpatient setting,330.85,50,,264.68,percent of total billed charges,50% of total billed charges for outpatient setting,330.85,50,,264.68,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,259.17,39.17,,207.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,231.6,549.21,
SEVELMER (RENAGEL) 800 MG TABLET,1634674,CDM,637,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
CLINDAMYCIN PALM(CLEOCIN) 75MG/5ML BTL,1634680,CDM,250,RC,,,outpatient,,,90.35,45.18,,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.69,38.4,,27.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.69,38.4,,27.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,67.76,75,,54.208,percent of total billed charges,75% of total billed charges for outpatient setting,67.76,75,,54.208,percent of total billed charges,75% of total billed charges for outpatient setting,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,67.76,75,,54.208,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.62,35,,25.296,percent of total billed charges,35% of total billed charges for outpatient setting,70.47,78,,56.376,percent of total billed charges,78% of total billed charges for outpatient setting,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.25,70,,50.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,75,,54.208,percent of total billed charges,75% of total billed charges for outpatient setting,74.99,83,,59.992,percent of total billed charges,83% of total billed charges for outpatient setting,45.18,50,,36.144,percent of total billed charges,50% of total billed charges for outpatient setting,45.18,50,,36.144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.38,39.17,,28.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.62,74.99,
AMIODARONE HCL  (CORDARONE) 150MG/3ML,1634681,CDM,636,RC,J0282,HCPCS,both,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
TUBERCULIN (APLISOL)  1ml VIAL,1634696,CDM,250,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
PERMETHRIN (ELMITE) 5% CREAM,1634704,CDM,250,RC,,,outpatient,,,71,35.5,,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.26,38.4,,21.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.85,35,,19.88,percent of total billed charges,35% of total billed charges for outpatient setting,55.38,78,,44.304,percent of total billed charges,78% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,49.7,70,,39.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.25,75,,42.6,percent of total billed charges,75% of total billed charges for outpatient setting,58.93,83,,47.144,percent of total billed charges,83% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,35.5,50,,28.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.81,39.17,,22.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.85,58.93,
SUCRALFATE (CARAFATE) 1 GRAM suspension,1634709,CDM,250,RC,,,outpatient,,,95.2,47.6,,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.56,38.4,,29.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.56,38.4,,29.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.32,35,,26.656,percent of total billed charges,35% of total billed charges for outpatient setting,74.26,78,,59.408,percent of total billed charges,78% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,66.64,70,,53.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.4,75,,57.12,percent of total billed charges,75% of total billed charges for outpatient setting,79.02,83,,63.216,percent of total billed charges,83% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,47.6,50,,38.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.29,39.17,,29.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.32,79.02,
NACL 0.45%/POTASS CHLOR 20MEQ/1000ML,1634711,CDM,250,RC,,,outpatient,,,15.4,7.7,,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.39,35,,4.312,percent of total billed charges,35% of total billed charges for outpatient setting,12.01,78,,9.608,percent of total billed charges,78% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,12.78,83,,10.224,percent of total billed charges,83% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.03,39.17,,4.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.39,12.78,
PrednisoLONE (PRELONE) 15MG/5ML DOSE,1634715,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OLMESARTAN (BENICAR) 40 MG TABLET,1634718,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MINERAL OIL/PET HY-PHL (AQUAPHOR) OINT,1634725,CDM,637,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
DIVALPROEX  DR (DEPAKOTE) 250 MG TAB,1634727,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
POLYETHYLENE GLYCOL 3350 (MIRALAX),1634728,CDM,250,RC,,,outpatient,,,26.6,13.3,,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.21,38.4,,8.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.21,38.4,,8.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.31,35,,7.448,percent of total billed charges,35% of total billed charges for outpatient setting,20.75,78,,16.6,percent of total billed charges,78% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,18.62,70,,14.896,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,75,,15.96,percent of total billed charges,75% of total billed charges for outpatient setting,22.08,83,,17.664,percent of total billed charges,83% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,13.3,50,,10.64,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.41,39.17,,8.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.31,22.08,
HYDROCORTISONE (CORTEF) 20 MG TABLET,1634736,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ZOLEDRONIC ACID (ZOMETA) 4MG/5ML,1634739,CDM,636,RC,J3487,HCPCS,both,,,3797.7,1898.85,,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1458.32,38.4,,1166.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1458.32,38.4,,1166.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,2848.28,75,,2278.624,percent of total billed charges,75% of total billed charges for outpatient setting,2848.28,75,,2278.624,percent of total billed charges,75% of total billed charges for outpatient setting,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,2848.28,75,,2278.624,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1329.2,35,,1063.36,percent of total billed charges,35% of total billed charges for outpatient setting,2962.21,78,,2369.768,percent of total billed charges,78% of total billed charges for outpatient setting,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,2658.39,70,,2126.712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2848.28,75,,2278.624,percent of total billed charges,75% of total billed charges for outpatient setting,3152.09,83,,2521.672,percent of total billed charges,83% of total billed charges for outpatient setting,1898.85,50,,1519.08,percent of total billed charges,50% of total billed charges for outpatient setting,1898.85,50,,1519.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1487.49,39.17,,1189.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1329.2,3152.09,
FENTANYL (SUBLIMAZE) 2500 MCG/50ML vial,1634746,CDM,636,RC,J3010,HCPCS,both,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,49.8,
GENTAMYCIN OPTH. OINT,1634750,CDM,637,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
EZETIMIBE (ZETIA) 10mg TABLET,1634753,CDM,637,RC,,,outpatient,,,57.4,28.7,,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.04,38.4,,17.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.04,38.4,,17.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,43.05,75,,34.44,percent of total billed charges,75% of total billed charges for outpatient setting,43.05,75,,34.44,percent of total billed charges,75% of total billed charges for outpatient setting,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,43.05,75,,34.44,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.09,35,,16.072,percent of total billed charges,35% of total billed charges for outpatient setting,44.77,78,,35.816,percent of total billed charges,78% of total billed charges for outpatient setting,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,40.18,70,,32.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.05,75,,34.44,percent of total billed charges,75% of total billed charges for outpatient setting,47.64,83,,38.112,percent of total billed charges,83% of total billed charges for outpatient setting,28.7,50,,22.96,percent of total billed charges,50% of total billed charges for outpatient setting,28.7,50,,22.96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.48,39.17,,17.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.09,47.64,
PRAVASTATIN (PRAVACHOL) 40 MG TABLET,1634755,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYOSCYAMINE (LEVSIN) 0.125 MG / 5ML DOSE,1634761,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TIOTROPIUM HANDIHALER(SPIRIVA) 18MCG INH,1634762,CDM,637,RC,,,outpatient,,,142,71,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.7,35,,39.76,percent of total billed charges,35% of total billed charges for outpatient setting,110.76,78,,88.608,percent of total billed charges,78% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.86,83,,94.288,percent of total billed charges,83% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.62,39.17,,44.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49.7,117.86,
MAGNESIUM SULFATE 4 GRAM/50ML BAG,1634767,CDM,250,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
SODIUM CHLORIDE 120MEQ/30ML VIAL,1634768,CDM,250,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
LINEZOLID (ZYVOX) 600MG/300ML IV SOLN,1634769,CDM,250,RC,J2020,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,70.55,
WARFARIN (COUMADIN) 1 MG TABLET,1634776,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CIPROFLOXACIN HCL (CIPRO) 500MG TAB,1634781,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUCONAZOLE (DIFLUCAN) 200MG TABLET,1634783,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PEGFILGRASTIM (NEULASTA) 6MG/0.6ML SYRN,1634789,CDM,636,RC,J2505,HCPCS,both,,,19005,9502.5,,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7297.92,38.4,,5838.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7297.92,38.4,,5838.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,14253.75,75,,11403,percent of total billed charges,75% of total billed charges for outpatient setting,14253.75,75,,11403,percent of total billed charges,75% of total billed charges for outpatient setting,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,14253.75,75,,11403,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6651.75,35,,5321.4,percent of total billed charges,35% of total billed charges for outpatient setting,14823.9,78,,11859.12,percent of total billed charges,78% of total billed charges for outpatient setting,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,13303.5,70,,10642.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14253.75,75,,11403,percent of total billed charges,75% of total billed charges for outpatient setting,15774.15,83,,12619.32,percent of total billed charges,83% of total billed charges for outpatient setting,9502.5,50,,7602,percent of total billed charges,50% of total billed charges for outpatient setting,9502.5,50,,7602,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7443.88,39.17,,5955.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6651.75,15774.15,
ISONIAZID (INH) 300 MG TABLET,1634791,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ETHAMBUTOL (MYAMBUTIL) 400 MG TABLET,1634793,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PYRIDOSTIGMINE (MESTINON) 60 MG TABLET,1634794,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PHENOBARBITAL 65 MG vial,1634795,CDM,250,RC,,,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
"ANTIVENIN,CROTALIDAE FAB (CROFAB) VIAL",1634796,CDM,636,RC,J0840,HCPCS,both,,,11045,5522.5,,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,1949.92,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,4241.28,38.4,,3393.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4241.28,38.4,,3393.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,8283.75,75,,6627,percent of total billed charges,75% of total billed charges for outpatient setting,8283.75,75,,6627,percent of total billed charges,75% of total billed charges for outpatient setting,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,8283.75,75,,6627,percent of total billed charges,75% of total billed charges for outpatient setting,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3865.75,35,,3092.6,percent of total billed charges,35% of total billed charges for outpatient setting,8615.1,78,,6892.08,percent of total billed charges,78% of total billed charges for outpatient setting,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,7731.5,70,,6185.2,percent of total billed charges,70% of total billed charges for outpatient setting,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,8283.75,75,,6627,percent of total billed charges,75% of total billed charges for outpatient setting,9167.35,83,,7333.88,percent of total billed charges,83% of total billed charges for outpatient setting,5522.5,50,,4418,percent of total billed charges,50% of total billed charges for outpatient setting,5522.5,50,,4418,percent of total billed charges,50% of total billed charges for outpatient setting,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4326.11,39.17,,3460.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1949.92,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1949.92,9167.35,
NYSTATIN/TRIAMCIN (MYCOLOG) CREAM 30GM,1634803,CDM,637,RC,,,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,90.47,
CEFTRIAXONE (ROCEPHIN) 1 GRAM VIAL,1634807,CDM,636,RC,J0696,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,4.15,
CEFTRIAXONE (ROCEPHIN) 500 MG VIAL,1634808,CDM,636,RC,J0696,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,4.15,
PACKING STRIP (NU-GAUZE) 1/4 INCH X 5YDS,1634812,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
MORPHINE 2 MG INJECTION,1634818,CDM,636,RC,J2270,HCPCS,both,,,9.8,4.9,,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,7.64,78,,6.112,percent of total billed charges,78% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,6.86,70,,5.488,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,75,,5.88,percent of total billed charges,75% of total billed charges for outpatient setting,8.13,83,,6.504,percent of total billed charges,83% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,4.9,50,,3.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,8.13,
FENTANYL (DURAGESIC) 12 MCG PATCH,1634821,CDM,637,RC,,,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,35,,15.96,percent of total billed charges,35% of total billed charges for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.33,39.17,,17.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.95,47.31,
LORATADINE (CLARITIN) 5MG/5ML SYRUP,1634882,CDM,637,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
MEMANTINE (NAMENDA) 10 MG TABLET,1634891,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DUTASTERIDE (AVODART) 0.5 MG capsule,1634892,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ACETYLCYSTEINE (ACETADOTE) 6000MG / 30ML,1634898,CDM,636,RC,J0132,HCPCS,both,,,733,366.5,,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,281.47,38.4,,225.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,281.47,38.4,,225.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,549.75,75,,439.8,percent of total billed charges,75% of total billed charges for outpatient setting,549.75,75,,439.8,percent of total billed charges,75% of total billed charges for outpatient setting,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,549.75,75,,439.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,256.55,35,,205.24,percent of total billed charges,35% of total billed charges for outpatient setting,571.74,78,,457.392,percent of total billed charges,78% of total billed charges for outpatient setting,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,513.1,70,,410.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,549.75,75,,439.8,percent of total billed charges,75% of total billed charges for outpatient setting,608.39,83,,486.712,percent of total billed charges,83% of total billed charges for outpatient setting,366.5,50,,293.2,percent of total billed charges,50% of total billed charges for outpatient setting,366.5,50,,293.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,287.1,39.17,,229.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,256.55,608.39,
SACCHAROMYCES BOUL(FLORASTOR) 250MG cap,1634901,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BRIMONIDINE (ALPHAGAN) 0.2% EYE DROP,1634907,CDM,637,RC,,,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
WARFARIN (COUMADIN) 3 MG TABLET,1634908,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MEROPENEM (MERREM) 500 MG vial,1634910,CDM,636,RC,J2185,HCPCS,both,,,18.2,9.1,,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,13.65,75,,10.92,percent of total billed charges,75% of total billed charges for outpatient setting,13.65,75,,10.92,percent of total billed charges,75% of total billed charges for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,13.65,75,,10.92,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,14.2,78,,11.36,percent of total billed charges,78% of total billed charges for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,12.74,70,,10.192,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,75,,10.92,percent of total billed charges,75% of total billed charges for outpatient setting,15.11,83,,12.088,percent of total billed charges,83% of total billed charges for outpatient setting,9.1,50,,7.28,percent of total billed charges,50% of total billed charges for outpatient setting,9.1,50,,7.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,15.11,
CEFDINIR (OMNICEF) 250 MG/5 ML UD,1634917,CDM,637,RC,,,outpatient,,,114,57,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.9,35,,31.92,percent of total billed charges,35% of total billed charges for outpatient setting,88.92,78,,71.136,percent of total billed charges,78% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,94.62,83,,75.696,percent of total billed charges,83% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.66,39.17,,35.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.9,94.62,
HUMALOG 100 UNITS/1ML VIAL,1634961,CDM,636,RC,J1817,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ZOLEDRONIC ACID (RECLAST) 5mg/100mL,1634964,CDM,636,RC,J3489,HCPCS,both,,,233,116.5,,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.21,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,181.74,78,,145.392,percent of total billed charges,78% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,163.1,70,,130.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.75,75,,139.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.39,83,,154.712,percent of total billed charges,83% of total billed charges for outpatient setting,116.5,50,,93.2,percent of total billed charges,50% of total billed charges for outpatient setting,116.5,50,,93.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.21,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.21,193.39,
PIPERACILLIN/TAZO(ZOSYN) 3.375GM VL,1634971,CDM,636,RC,J2543,HCPCS,both,,,10.97,5.49,,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.24,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.56,78,,6.848,percent of total billed charges,78% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,7.68,70,,6.144,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.23,75,,6.584,percent of total billed charges,75% of total billed charges for outpatient setting,9.11,83,,7.288,percent of total billed charges,83% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,5.49,50,,4.392,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.18,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.18,9.11,
HYDROCHLOROTHIAZIDE(MICROZIDE)12.5MG cap,1634975,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
METOPROLOL (LOPRESSOR) 25 MG TABLET,1634976,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MEROPENEM (MERREM) 1 GRAM vial,1634979,CDM,636,RC,J2185,HCPCS,both,,,21.94,10.97,,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,17.11,78,,13.688,percent of total billed charges,78% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,15.36,70,,12.288,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.46,75,,13.168,percent of total billed charges,75% of total billed charges for outpatient setting,18.21,83,,14.568,percent of total billed charges,83% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,10.97,50,,8.776,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.45,18.21,
METHYLNALTREXONE (RELISTOR) 12 MG INJ,1634992,CDM,637,RC,,,outpatient,,,386,193,,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.22,38.4,,118.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.22,38.4,,118.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.1,35,,108.08,percent of total billed charges,35% of total billed charges for outpatient setting,301.08,78,,240.864,percent of total billed charges,78% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,270.2,70,,216.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,289.5,75,,231.6,percent of total billed charges,75% of total billed charges for outpatient setting,320.38,83,,256.304,percent of total billed charges,83% of total billed charges for outpatient setting,193,50,,154.4,percent of total billed charges,50% of total billed charges for outpatient setting,193,50,,154.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.18,39.17,,120.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,135.1,320.38,
DULOXETINE (CYMBALTA) 30 MG capsule,1660262,CDM,250,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
HUMALOG MIX 75/25 INS 100 U / ML VIAL,1660263,CDM,637,RC,J1815,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,4.15,
RANITIDINE (ZANTAC) SYRUP 75mg/5ml,1660269,CDM,637,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
METOCLOPRAMIDE (REGLAN) 10 MG/10ML EACH,1660270,CDM,637,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
LANTUS (LEVEMIR) 100 UNITS/1ML,1660271,CDM,637,RC,J1815,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.33,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.31,4.15,
ROSUVASTATIN (CRESTOR) 10 MG TABLET,1660280,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM HYPOCHL(DAKINS) 0.25% SOLN,1660287,CDM,250,RC,,,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
ALBUTEROL / IPRATROP(DUONEB) 0.5/3MG 3ML,1660302,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FENTANYL (DURAGESIC) 25 MCG patch,1660304,CDM,250,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
HYDROXYUREA (HYDREA) 500 MG capsule,1660321,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREGABALIN (LYRICA) 100 MG capsule,1660336,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREGABALIN (LYRICA) 75 MG capsule,1660337,CDM,637,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
MELOXICAM (MOBIC) 7.5 MG TABLET,1660347,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROMETHAZINE (PHENERGAN) 12.5MG SUPP,1660373,CDM,637,RC,,,outpatient,,,35.19,17.6,,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.51,38.4,,10.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.51,38.4,,10.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,26.39,75,,21.112,percent of total billed charges,75% of total billed charges for outpatient setting,26.39,75,,21.112,percent of total billed charges,75% of total billed charges for outpatient setting,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,26.39,75,,21.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.32,35,,9.856,percent of total billed charges,35% of total billed charges for outpatient setting,27.45,78,,21.96,percent of total billed charges,78% of total billed charges for outpatient setting,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,24.63,70,,19.704,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.39,75,,21.112,percent of total billed charges,75% of total billed charges for outpatient setting,29.21,83,,23.368,percent of total billed charges,83% of total billed charges for outpatient setting,17.6,50,,14.08,percent of total billed charges,50% of total billed charges for outpatient setting,17.6,50,,14.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.78,39.17,,11.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.32,29.21,
RANOLAZINE (RANEXA) 500MG TAB,1660392,CDM,637,RC,,,outpatient,,,30.8,15.4,,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.83,38.4,,9.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.83,38.4,,9.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.78,35,,8.624,percent of total billed charges,35% of total billed charges for outpatient setting,24.02,78,,19.216,percent of total billed charges,78% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,21.56,70,,17.248,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,75,,18.48,percent of total billed charges,75% of total billed charges for outpatient setting,25.56,83,,20.448,percent of total billed charges,83% of total billed charges for outpatient setting,15.4,50,,12.32,percent of total billed charges,50% of total billed charges for outpatient setting,15.4,50,,12.32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.07,39.17,,9.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.78,25.56,
ROPINIROLE HCL (REQUIP) 0.25MG TAB,1660399,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ROPINIROLE (REQUIP) 1 MG TABLET,1660400,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TOPIRAMATE (TOPAMAX) 100 MG TABLET,1660418,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DICLOFENAC SODIUM (VOLTAREN) 75MG TABLET,1660437,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUPROPIN XL (WELLBUTRIN XL) 150 MG TAB,1660440,CDM,637,RC,,,outpatient,,,5.91,2.96,,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.27,38.4,,1.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.07,35,,1.656,percent of total billed charges,35% of total billed charges for outpatient setting,4.61,78,,3.688,percent of total billed charges,78% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,4.14,70,,3.312,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,75,,3.544,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,83,,3.928,percent of total billed charges,83% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,2.96,50,,2.368,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,39.17,,1.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.07,4.91,
TIZANIDINE (ZANAFLEX) 4 MG TABLET,1660444,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PENICILLIN G (BICILLIN LA) 600KUNIT,1660453,CDM,636,RC,J0560,HCPCS,both,,,322,161,,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123.65,38.4,,98.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.65,38.4,,98.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,75,,193.2,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,75,,193.2,percent of total billed charges,75% of total billed charges for outpatient setting,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,75,,193.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.7,35,,90.16,percent of total billed charges,35% of total billed charges for outpatient setting,251.16,78,,200.928,percent of total billed charges,78% of total billed charges for outpatient setting,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,225.4,70,,180.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,241.5,75,,193.2,percent of total billed charges,75% of total billed charges for outpatient setting,267.26,83,,213.808,percent of total billed charges,83% of total billed charges for outpatient setting,161,50,,128.8,percent of total billed charges,50% of total billed charges for outpatient setting,161,50,,128.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.12,39.17,,100.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,112.7,267.26,
BENAZEPRIL (LOTENSIN) 20 MG TABLET,1660455,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KETOROLAC (TORADOL) 60 MG vial,1668336,CDM,636,RC,J1885,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,4.15,
LEUCOVORIN CALCIUM 350mg vial,1668755,CDM,636,RC,J0640,HCPCS,both,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,49.8,
LEUCOVORIN CALCIUM 100mg/15ml VIAL,1668756,CDM,636,RC,J0640,HCPCS,both,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.47,29.88,
AMINOPHYLLINE 500mg/20mL VIAL,1668760,CDM,636,RC,J0280,HCPCS,both,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.13,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.13,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.13,19.92,
QUETIAPINE (SEROQUEL) 25MG TABLET,1668769,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MAGNESIUM SULFATE 2GM/50ML BAG,1668784,CDM,636,RC,J3475,HCPCS,both,,,21.1,10.55,,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,16.46,78,,13.168,percent of total billed charges,78% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,14.77,70,,11.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.83,75,,12.664,percent of total billed charges,75% of total billed charges for outpatient setting,17.51,83,,14.008,percent of total billed charges,83% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,10.55,50,,8.44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,17.51,
LIDOCAINE (LIDODERM) 5% 700 MG patch,1668797,CDM,637,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
ONDANSETRON ODT (ZOFRAN ODT) 4 MG TABLET,1668800,CDM,637,RC,Q0162,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MUPIROCIN (BACTROBAN) 2 % OINTMENT,1668803,CDM,637,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
"ERGOCALCIFEROL (DRISDOL) 50,000 UNIT CAP",1668814,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CHOLECALCIFEROL (VITAMIN D3) 400IU TAB,1668815,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FOSPHENYTOIN (CEREBYX) 500mg PE/10mL VL,1668847,CDM,250,RC,,,outpatient,,,214,107,,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.18,38.4,,65.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.18,38.4,,65.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,160.5,75,,128.4,percent of total billed charges,75% of total billed charges for outpatient setting,160.5,75,,128.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,160.5,75,,128.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.9,35,,59.92,percent of total billed charges,35% of total billed charges for outpatient setting,166.92,78,,133.536,percent of total billed charges,78% of total billed charges for outpatient setting,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,149.8,70,,119.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.5,75,,128.4,percent of total billed charges,75% of total billed charges for outpatient setting,177.62,83,,142.096,percent of total billed charges,83% of total billed charges for outpatient setting,107,50,,85.6,percent of total billed charges,50% of total billed charges for outpatient setting,107,50,,85.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,83.82,39.17,,67.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,74.9,177.62,
BETAMETHASONE VAL(BETA-VAL) 0.1% CRM,1668848,CDM,637,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
SCOPOLAMINE(TRANSDERM-SCOP) 1.5mg PATCH,1668852,CDM,637,RC,,,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
BUDESONIDE/FORM (SYMBICORT) 80/4.5 INH,1668866,CDM,637,RC,,,outpatient,,,583,291.5,,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.87,38.4,,179.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.87,38.4,,179.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.05,35,,163.24,percent of total billed charges,35% of total billed charges for outpatient setting,454.74,78,,363.792,percent of total billed charges,78% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,483.89,83,,387.112,percent of total billed charges,83% of total billed charges for outpatient setting,291.5,50,,233.2,percent of total billed charges,50% of total billed charges for outpatient setting,291.5,50,,233.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.35,39.17,,182.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,204.05,483.89,
METHIMAZOLE (TAPAZOLE) 10 MG TABLET,1668885,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AZITHROMYCIN (ZITHROMAX) 300MG/15ML SUSP,1668887,CDM,637,RC,,,outpatient,,,92,46,,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.33,38.4,,28.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.2,35,,25.76,percent of total billed charges,35% of total billed charges for outpatient setting,71.76,78,,57.408,percent of total billed charges,78% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,64.4,70,,51.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69,75,,55.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.36,83,,61.088,percent of total billed charges,83% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,46,50,,36.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.04,39.17,,28.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.2,76.36,
BUDESONIDE/FORM (SYMBICORT) 160/4.5 INH,1668894,CDM,637,RC,,,outpatient,,,583,291.5,,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.87,38.4,,179.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.87,38.4,,179.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.05,35,,163.24,percent of total billed charges,35% of total billed charges for outpatient setting,454.74,78,,363.792,percent of total billed charges,78% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,408.1,70,,326.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,437.25,75,,349.8,percent of total billed charges,75% of total billed charges for outpatient setting,483.89,83,,387.112,percent of total billed charges,83% of total billed charges for outpatient setting,291.5,50,,233.2,percent of total billed charges,50% of total billed charges for outpatient setting,291.5,50,,233.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.35,39.17,,182.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,204.05,483.89,
HYPERTONIC SALINE 3% BAG 500ML,1668925,CDM,258,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
"HEPARIN SODIUM,PORCINE/PF 100unit/1mL",1668926,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DENOSUMAB (PROLIA) 60MG/1ML,1668933,CDM,636,RC,J0897,HCPCS,both,,,4380,2190,,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,3285,75,,2628,percent of total billed charges,75% of total billed charges for outpatient setting,3285,75,,2628,percent of total billed charges,75% of total billed charges for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,3285,75,,2628,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3416.4,78,,2733.12,percent of total billed charges,78% of total billed charges for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,3066,70,,2452.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3285,75,,2628,percent of total billed charges,75% of total billed charges for outpatient setting,3635.4,83,,2908.32,percent of total billed charges,83% of total billed charges for outpatient setting,2190,50,,1752,percent of total billed charges,50% of total billed charges for outpatient setting,2190,50,,1752,percent of total billed charges,50% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,3635.4,
IBUPROFEN (MOTRIN) SUSp 100 MG/5ML DOSE,1668941,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KETOROLAC (TORADOL) 10 MG TABLET,1668943,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IODOFORM 1/4 INCH,1668944,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
ZIPRASIDONE (GEODON) 20MG/ML INJ,1668950,CDM,636,RC,J3486,HCPCS,both,,,176,88,,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,9.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,137.28,78,,109.824,percent of total billed charges,78% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.08,83,,116.864,percent of total billed charges,83% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.76,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.76,146.08,
AMOXICILLIN/CLAV(AUGMENTIN) 600MG BOTTLE,1668954,CDM,637,RC,,,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.15,35,,13.72,percent of total billed charges,35% of total billed charges for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,39.17,,15.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.15,40.67,
IBUPROFEN (MOTRIN) 800 MG TAB,1668957,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CHOLECALCIFEROL (VITAMIN D3) 1000 IU TAB,1668966,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MAGNESIUM SULFATE 50% 20mEq/10mL SYRINGE,1668975,CDM,250,RC,J3475,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,46.48,
PROMETH W/COD (PHENERGAN W/COD) 10MG/5ML,1668978,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVALBUTEROL(XOPENEX) 1.25mg/3mL SOLN,1668982,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROCODONE BIT/APAP 7.5/325MG TAB,1668983,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
COLCHICINE (COLCRYS) 0.6 MG TABLET,1668984,CDM,637,RC,,,outpatient,,,16.88,8.44,,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.48,38.4,,5.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.48,38.4,,5.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.91,35,,4.728,percent of total billed charges,35% of total billed charges for outpatient setting,13.17,78,,10.536,percent of total billed charges,78% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,11.82,70,,9.456,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.66,75,,10.128,percent of total billed charges,75% of total billed charges for outpatient setting,14.01,83,,11.208,percent of total billed charges,83% of total billed charges for outpatient setting,8.44,50,,6.752,percent of total billed charges,50% of total billed charges for outpatient setting,8.44,50,,6.752,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.61,39.17,,5.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.91,14.01,
SODIUM CHLORIDE 0.9% FLUSH 10ML PFS,1668985,CDM,258,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROCODONE / APAP (NORCO) 5/325 MG TAB,1668986,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SITAGLIPTIN (JANUVIA) 50 MG TABLET,1668994,CDM,637,RC,,,outpatient,,,44.73,22.37,,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.18,38.4,,13.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.18,38.4,,13.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.66,35,,12.528,percent of total billed charges,35% of total billed charges for outpatient setting,34.89,78,,27.912,percent of total billed charges,78% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,31.31,70,,25.048,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.55,75,,26.84,percent of total billed charges,75% of total billed charges for outpatient setting,37.13,83,,29.704,percent of total billed charges,83% of total billed charges for outpatient setting,22.37,50,,17.896,percent of total billed charges,50% of total billed charges for outpatient setting,22.37,50,,17.896,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.52,39.17,,14.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.66,37.13,
ALBUTEROL SULF (VENTOLIN) 90mcg INHALER,1669001,CDM,637,RC,,,outpatient,,,234,117,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.9,35,,65.52,percent of total billed charges,35% of total billed charges for outpatient setting,182.52,78,,146.016,percent of total billed charges,78% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.22,83,,155.376,percent of total billed charges,83% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.66,39.17,,73.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.9,194.22,
PIPERACILLIN/TAZO (ZOSYN) 2.25GM VL,1669006,CDM,637,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
FLUTICASONE/SALMET(ADVAIR) 250MCG INH,1669014,CDM,637,RC,,,outpatient,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,410.85,
FLUTICASONE/SALMET (ADVAIR) 500MCG INH,1669015,CDM,637,RC,,,outpatient,,,522,261,,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,200.45,38.4,,160.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.45,38.4,,160.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,391.5,75,,313.2,percent of total billed charges,75% of total billed charges for outpatient setting,391.5,75,,313.2,percent of total billed charges,75% of total billed charges for outpatient setting,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,391.5,75,,313.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.7,35,,146.16,percent of total billed charges,35% of total billed charges for outpatient setting,407.16,78,,325.728,percent of total billed charges,78% of total billed charges for outpatient setting,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,365.4,70,,292.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,391.5,75,,313.2,percent of total billed charges,75% of total billed charges for outpatient setting,433.26,83,,346.608,percent of total billed charges,83% of total billed charges for outpatient setting,261,50,,208.8,percent of total billed charges,50% of total billed charges for outpatient setting,261,50,,208.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,204.46,39.17,,163.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,182.7,433.26,
FLUTICASONE/SALMET(ADVAIR) 100MCG INH,1669016,CDM,637,RC,,,outpatient,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,410.85,
CARVEDILOL (COREG) 6.25 MG TABLET,1669023,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CARVEDILOL (COREG) 12.5 MG TABLET,1669024,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SODIUM CL/POTAS CL(THERMOTABS)452mg TAB,1669030,CDM,637,RC,J2790,HCPCS,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,81.16,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.16,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.5,85.22,
NF-OSELTAMIVIR (TAMIFLU) 30mg/5ml UD,1669033,CDM,637,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
ACETAMINOPHEN (TYLENOL) 325 MG TABLET,1669035,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
RACEPINEPHRINE 2.25% VIAL INHAL SOL,1669045,CDM,250,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BUPIVACAINE HCL/PF (MARCAINE) 75mg/30mL,1669049,CDM,637,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
GUAIFENESIN/D-METHORPHAN 200mg/10ml UD,1669052,CDM,250,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
DABIGATRAN ETEXILATE (PRADAXA) 75 MG TAB,1669058,CDM,250,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
RIVAROXABAN (XARELTO) 10 MG TABLET,1669070,CDM,637,RC,,,outpatient,,,33.76,16.88,,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.96,38.4,,10.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.96,38.4,,10.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,25.32,75,,20.256,percent of total billed charges,75% of total billed charges for outpatient setting,25.32,75,,20.256,percent of total billed charges,75% of total billed charges for outpatient setting,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,25.32,75,,20.256,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.82,35,,9.456,percent of total billed charges,35% of total billed charges for outpatient setting,26.33,78,,21.064,percent of total billed charges,78% of total billed charges for outpatient setting,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,23.63,70,,18.904,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.32,75,,20.256,percent of total billed charges,75% of total billed charges for outpatient setting,28.02,83,,22.416,percent of total billed charges,83% of total billed charges for outpatient setting,16.88,50,,13.504,percent of total billed charges,50% of total billed charges for outpatient setting,16.88,50,,13.504,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.22,39.17,,10.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.82,28.02,
BEVACIZUMAB (AVASTIN) 10mg/0.4mL VIAL,1669072,CDM,636,RC,J9035,HCPCS,both,,,288,144,,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,74.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,74.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.07,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.77,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,224.64,78,,179.712,percent of total billed charges,78% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,83,,191.232,percent of total billed charges,83% of total billed charges for outpatient setting,144,50,,115.2,percent of total billed charges,50% of total billed charges for outpatient setting,144,50,,115.2,percent of total billed charges,50% of total billed charges for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.07,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,74.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.06,239.04,
OMEGA-3 FATTY ACID(FISH OIL) 1000mg CAP,1669085,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IRON SUCROSE CMPLX(VENOFER) 100mg/5mL VL,1669094,CDM,636,RC,J1756,HCPCS,both,,,110,55,,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.22,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,85.8,78,,68.64,percent of total billed charges,78% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,77,70,,61.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.5,75,,66,percent of total billed charges,75% of total billed charges for outpatient setting,91.3,83,,73.04,percent of total billed charges,83% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,55,50,,44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.22,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.22,91.3,
PANCRELIPASE (ZENPEP) 5000 UNITS capsule,1669096,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DENOSUMAB (XGEVA) 120mg/1.7mL VIAL,1669097,CDM,636,RC,J0897,HCPCS,both,,,8013,4006.5,,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,6009.75,75,,4807.8,percent of total billed charges,75% of total billed charges for outpatient setting,6009.75,75,,4807.8,percent of total billed charges,75% of total billed charges for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,6009.75,75,,4807.8,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.46,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,6250.14,78,,5000.112,percent of total billed charges,78% of total billed charges for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,5609.1,70,,4487.28,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6009.75,75,,4807.8,percent of total billed charges,75% of total billed charges for outpatient setting,6650.79,83,,5320.632,percent of total billed charges,83% of total billed charges for outpatient setting,4006.5,50,,3205.2,percent of total billed charges,50% of total billed charges for outpatient setting,4006.5,50,,3205.2,percent of total billed charges,50% of total billed charges for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.2,6650.79,
RIVAROXABAN (XARELTO) 15 MG TABLET,1669098,CDM,636,RC,,,both,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,46.48,
DIPHENHYDRAMINE/ZINC(BENADRYL)SPRAY 59ml,1669109,CDM,637,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
HYDROMORPHONE HCL (DILAUDID) 2 MG INJ,1669112,CDM,636,RC,J1170,HCPCS,both,,,11.2,5.6,,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.74,78,,6.992,percent of total billed charges,78% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,83,,7.44,percent of total billed charges,83% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,9.3,
"TETANUS,DIPHTH,PERTUSSIS (ADACELL) DOSE",1669113,CDM,636,RC,90715,HCPCS,both,,,92.84,46.42,,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.31,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,69.63,75,,55.704,percent of total billed charges,75% of total billed charges for outpatient setting,69.63,75,,55.704,percent of total billed charges,75% of total billed charges for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,69.63,75,,55.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.23,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,72.42,78,,57.936,percent of total billed charges,78% of total billed charges for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,64.99,70,,51.992,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.63,75,,55.704,percent of total billed charges,75% of total billed charges for outpatient setting,77.06,83,,61.648,percent of total billed charges,83% of total billed charges for outpatient setting,46.42,50,,37.136,percent of total billed charges,50% of total billed charges for outpatient setting,46.42,50,,37.136,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.31,77.06,
ADENOSINE 3mg/1mL VIAL,1669115,CDM,636,RC,,,both,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
PSYLLIUM  W/SUGAR (METAMUCIL) PKT,1669132,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
AMIODARONE IN DEXTROSE 360mg/200ml BAG,1669136,CDM,636,RC,J0282,HCPCS,both,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.95,35,,38.36,percent of total billed charges,35% of total billed charges for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.66,39.17,,42.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.95,113.71,
AMIODARONE IN DEXTROSE 150mg/100mL BAG,1669137,CDM,636,RC,J0282,HCPCS,both,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.05,35,,34.44,percent of total billed charges,35% of total billed charges for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.17,39.17,,38.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.05,102.09,
REGADENOSON (LEXISCAN) 0.4MG/5ML INJ,1669138,CDM,636,RC,J2785,HCPCS,both,,,659.16,329.58,,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,494.37,75,,395.496,percent of total billed charges,75% of total billed charges for outpatient setting,494.37,75,,395.496,percent of total billed charges,75% of total billed charges for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,494.37,75,,395.496,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.99,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,514.14,78,,411.312,percent of total billed charges,78% of total billed charges for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,461.41,70,,369.128,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,494.37,75,,395.496,percent of total billed charges,75% of total billed charges for outpatient setting,547.1,83,,437.68,percent of total billed charges,83% of total billed charges for outpatient setting,329.58,50,,263.664,percent of total billed charges,50% of total billed charges for outpatient setting,329.58,50,,263.664,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.28,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.28,547.1,
MEGESTROL (MEGACE) 400 MG suspension,1669139,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PREGABALIN (LYRICA) 50 MG capsule,1669141,CDM,636,RC,,,both,,,43.4,21.7,,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.67,38.4,,13.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.67,38.4,,13.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,32.55,75,,26.04,percent of total billed charges,75% of total billed charges for outpatient setting,32.55,75,,26.04,percent of total billed charges,75% of total billed charges for outpatient setting,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,32.55,75,,26.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.19,35,,12.152,percent of total billed charges,35% of total billed charges for outpatient setting,33.85,78,,27.08,percent of total billed charges,78% of total billed charges for outpatient setting,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,30.38,70,,24.304,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,75,,26.04,percent of total billed charges,75% of total billed charges for outpatient setting,36.02,83,,28.816,percent of total billed charges,83% of total billed charges for outpatient setting,21.7,50,,17.36,percent of total billed charges,50% of total billed charges for outpatient setting,21.7,50,,17.36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17,39.17,,13.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.19,36.02,
AMOXICILLIN (AMOXIL) 400mg/5mL SUSP,1669142,CDM,250,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
LACTULOSE 20gram/30ML SOLN,1669143,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NYSTATIN ORAL 500000unit/5mL suspension,1669144,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROCHLORPERAZINE (COMPAZINE) 10 MG vial,1669146,CDM,636,RC,J0780,HCPCS,both,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.43,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.43,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.43,29.88,
TRANEXAMIC ACID(CYKLOKAPRON)1000MG/ML vl,1669147,CDM,250,RC,,,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.9,61.42,
NALOXONE (NARCAN) HCL 1mg/1mL SYRINGE,1669150,CDM,250,RC,,,outpatient,,,106,53,,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.7,38.4,,32.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.7,38.4,,32.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.1,35,,29.68,percent of total billed charges,35% of total billed charges for outpatient setting,82.68,78,,66.144,percent of total billed charges,78% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,74.2,70,,59.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.5,75,,63.6,percent of total billed charges,75% of total billed charges for outpatient setting,87.98,83,,70.384,percent of total billed charges,83% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,53,50,,42.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.51,39.17,,33.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.1,87.98,
MIDODRINE 5 MG TABLET,1669151,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
APIXABAN (ELIQUIS) 5 MG TABLET,1669155,CDM,250,RC,,,outpatient,,,16.04,8.02,,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.16,38.4,,4.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.16,38.4,,4.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.61,35,,4.488,percent of total billed charges,35% of total billed charges for outpatient setting,12.51,78,,10.008,percent of total billed charges,78% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,11.23,70,,8.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.03,75,,9.624,percent of total billed charges,75% of total billed charges for outpatient setting,13.31,83,,10.648,percent of total billed charges,83% of total billed charges for outpatient setting,8.02,50,,6.416,percent of total billed charges,50% of total billed charges for outpatient setting,8.02,50,,6.416,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.28,39.17,,5.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.61,13.31,
DOCUSATE SODIUM 100mg/10mL,1669156,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VANCOMYCIN 750 MG VIAL INJ,1669159,CDM,250,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
POTASSIUM CHLORIDE 10% 20mEq/15mL SOLN,1669160,CDM,250,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
PACLITAXEL PRTN-BND (ABRAXANE) 100mg VL,1669161,CDM,250,RC,J9264,HCPCS,outpatient,,,4713,2356.5,,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,14.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,3676.14,78,,2940.912,percent of total billed charges,78% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,3299.1,70,,2639.28,percent of total billed charges,70% of total billed charges for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3534.75,75,,2827.8,percent of total billed charges,75% of total billed charges for outpatient setting,3911.79,83,,3129.432,percent of total billed charges,83% of total billed charges for outpatient setting,2356.5,50,,1885.2,percent of total billed charges,50% of total billed charges for outpatient setting,2356.5,50,,1885.2,percent of total billed charges,50% of total billed charges for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,14.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.29,3911.79,
EDROPHONIUM (ENLON) 150MG/15ML vial,1669163,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LEVETIRACETAM (KEPPRA) 500mg/5mL VIAL,1669164,CDM,250,RC,,,outpatient,,,8.44,4.22,,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.24,38.4,,2.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.95,35,,2.36,percent of total billed charges,35% of total billed charges for outpatient setting,6.58,78,,5.264,percent of total billed charges,78% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,5.91,70,,4.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.33,75,,5.064,percent of total billed charges,75% of total billed charges for outpatient setting,7.01,83,,5.608,percent of total billed charges,83% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,4.22,50,,3.376,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.3,39.17,,2.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.95,7.01,
ROPIVACAINE 0.75% (NAROPIN) 150MG/20ML,1669165,CDM,250,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
HYDRALAZINE (APRESOLINE) 10 MG TABLET,1688901,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ALBUMIN (HUMAN) 25% 25GM/100ML IV,1688902,CDM,636,RC,,,both,,,298,149,,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.43,38.4,,91.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.43,38.4,,91.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.3,35,,83.44,percent of total billed charges,35% of total billed charges for outpatient setting,232.44,78,,185.952,percent of total billed charges,78% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,247.34,83,,197.872,percent of total billed charges,83% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.72,39.17,,93.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,104.3,247.34,
MINERIN CREME (EUCERIN) 160Z JAR,1688903,CDM,636,RC,,,both,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
LIDO2.5%/PRILO2.5% (EMLA) CREAM 30GM,1688904,CDM,636,RC,,,both,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
OSELTAMIVIR (TAMIFLU) 360mg/60ml BOTTLE,1688906,CDM,637,RC,,,outpatient,,,244,122,,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.7,38.4,,74.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.7,38.4,,74.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,183,75,,146.4,percent of total billed charges,75% of total billed charges for outpatient setting,183,75,,146.4,percent of total billed charges,75% of total billed charges for outpatient setting,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,183,75,,146.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.4,35,,68.32,percent of total billed charges,35% of total billed charges for outpatient setting,190.32,78,,152.256,percent of total billed charges,78% of total billed charges for outpatient setting,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,170.8,70,,136.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183,75,,146.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.52,83,,162.016,percent of total billed charges,83% of total billed charges for outpatient setting,122,50,,97.6,percent of total billed charges,50% of total billed charges for outpatient setting,122,50,,97.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.57,39.17,,76.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.4,202.52,
FAT EMULSION (INTRALIPID) 20% 250 ML,1688907,CDM,636,RC,,,both,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.15,35,,13.72,percent of total billed charges,35% of total billed charges for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,39.17,,15.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.15,40.67,
ATENOLOL (TENORMIN) 25MG TAB,1688909,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
IRON DEXTRAN (INFED) 100MG/2ML VIAL,1688910,CDM,636,RC,,,both,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.9,78.02,
JUST LIKE TEMPLATE   PHARMACY (78 / 250),1688911,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
MANNITOL INJECTION 25%,1688913,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
VANCOMYCIN (VANCOCIN) 125MG CAPSULE,1688917,CDM,637,RC,,,outpatient,,,15.19,7.6,,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.83,38.4,,4.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.32,35,,4.256,percent of total billed charges,35% of total billed charges for outpatient setting,11.85,78,,9.48,percent of total billed charges,78% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,10.63,70,,8.504,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.39,75,,9.112,percent of total billed charges,75% of total billed charges for outpatient setting,12.61,83,,10.088,percent of total billed charges,83% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,7.6,50,,6.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,39.17,,4.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.32,12.61,
SULFASALAZINE (AZULFIDINE) 500MG TABLET,1688919,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CHLORHEXIDINE GLUCONATE (HIBICLENS) 4OZ,1688920,CDM,637,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
DOPAMINE 200 MG / 5 ML VIAL,1688921,CDM,636,RC,,,both,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
LINEZOLID (ZYVOX) 600 MG TABLET,1688922,CDM,637,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
ETOMIDATE (AMIDATE) 20MG/10ML VIAL,1688923,CDM,636,RC,,,both,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
PRAMIPEXOLE (MIRAPEX) 0.5MG TAB,1688924,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
INFLIXIMAB (REMICADE) 100MG VIAL,1688925,CDM,636,RC,,,both,,,3375,1687.5,,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1296,38.4,,1036.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1296,38.4,,1036.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,2531.25,75,,2025,percent of total billed charges,75% of total billed charges for outpatient setting,2531.25,75,,2025,percent of total billed charges,75% of total billed charges for outpatient setting,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,2531.25,75,,2025,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1181.25,35,,945,percent of total billed charges,35% of total billed charges for outpatient setting,2632.5,78,,2106,percent of total billed charges,78% of total billed charges for outpatient setting,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,2362.5,70,,1890,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2531.25,75,,2025,percent of total billed charges,75% of total billed charges for outpatient setting,2801.25,83,,2241,percent of total billed charges,83% of total billed charges for outpatient setting,1687.5,50,,1350,percent of total billed charges,50% of total billed charges for outpatient setting,1687.5,50,,1350,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1321.92,39.17,,1057.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1181.25,2801.25,
PROCAINAMIDE (PRONESTYL) 1GM/2ML VIAL,1688931,CDM,250,RC,,,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,35,,67.2,percent of total billed charges,35% of total billed charges for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94,39.17,,75.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84,199.2,
TERBUTALINE (BRETHINE) 1MG/1ML INJ,1688935,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ADENOSINE (ADENOCARD) 6MG/2ML EMS CHARGE,1688937,CDM,636,RC,J0153,HCPCS,both,,,2.29,1.15,,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,1.72,75,,1.376,percent of total billed charges,75% of total billed charges for outpatient setting,1.72,75,,1.376,percent of total billed charges,75% of total billed charges for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,1.72,75,,1.376,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1.79,78,,1.432,percent of total billed charges,78% of total billed charges for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,1.6,70,,1.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.72,75,,1.376,percent of total billed charges,75% of total billed charges for outpatient setting,1.9,83,,1.52,percent of total billed charges,83% of total billed charges for outpatient setting,1.15,50,,0.92,percent of total billed charges,50% of total billed charges for outpatient setting,1.15,50,,0.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,1.9,
ALBUTEROL 2.5MG/3ML EMS CHARGE,1688938,CDM,637,RC,,,outpatient,,,0.12,0.06,,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.05,38.4,,0.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.05,38.4,,0.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,0.09,75,,0.072,percent of total billed charges,75% of total billed charges for outpatient setting,0.09,75,,0.072,percent of total billed charges,75% of total billed charges for outpatient setting,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,0.09,75,,0.072,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.04,35,,0.032,percent of total billed charges,35% of total billed charges for outpatient setting,0.09,78,,0.072,percent of total billed charges,78% of total billed charges for outpatient setting,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,0.08,70,,0.064,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.09,75,,0.072,percent of total billed charges,75% of total billed charges for outpatient setting,0.1,83,,0.08,percent of total billed charges,83% of total billed charges for outpatient setting,0.06,50,,0.048,percent of total billed charges,50% of total billed charges for outpatient setting,0.06,50,,0.048,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.05,39.17,,0.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.04,0.1,
AMIODARONE HCL150MG/3ML EMS CHARGE,1688939,CDM,636,RC,J0282,HCPCS,both,,,4.35,2.18,,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.67,38.4,,1.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.67,38.4,,1.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,3.26,75,,2.608,percent of total billed charges,75% of total billed charges for outpatient setting,3.26,75,,2.608,percent of total billed charges,75% of total billed charges for outpatient setting,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,3.26,75,,2.608,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.52,35,,1.216,percent of total billed charges,35% of total billed charges for outpatient setting,3.39,78,,2.712,percent of total billed charges,78% of total billed charges for outpatient setting,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,3.05,70,,2.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.26,75,,2.608,percent of total billed charges,75% of total billed charges for outpatient setting,3.61,83,,2.888,percent of total billed charges,83% of total billed charges for outpatient setting,2.18,50,,1.744,percent of total billed charges,50% of total billed charges for outpatient setting,2.18,50,,1.744,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.7,39.17,,1.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.52,3.61,
DEPO-MEDROL 40MG VL  O/P CLINC CHARGE,1688940,CDM,636,RC,J1030,HCPCS,both,,,6.69,3.35,,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.42,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,5.02,75,,4.016,percent of total billed charges,75% of total billed charges for outpatient setting,5.02,75,,4.016,percent of total billed charges,75% of total billed charges for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,5.02,75,,4.016,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.74,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.22,78,,4.176,percent of total billed charges,78% of total billed charges for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,4.68,70,,3.744,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.02,75,,4.016,percent of total billed charges,75% of total billed charges for outpatient setting,5.55,83,,4.44,percent of total billed charges,83% of total billed charges for outpatient setting,3.35,50,,2.68,percent of total billed charges,50% of total billed charges for outpatient setting,3.35,50,,2.68,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.35,6.74,
LIDOCAINE1% 200MG/20ML O/P CLINIC CHARGE,1688941,CDM,250,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
BUPIVACAINE W/EPI 0.5% 50ML O/P CLINIC,1688942,CDM,250,RC,,,outpatient,,,3.49,1.75,,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.34,38.4,,1.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.34,38.4,,1.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,2.62,75,,2.096,percent of total billed charges,75% of total billed charges for outpatient setting,2.62,75,,2.096,percent of total billed charges,75% of total billed charges for outpatient setting,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,2.62,75,,2.096,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.22,35,,0.976,percent of total billed charges,35% of total billed charges for outpatient setting,2.72,78,,2.176,percent of total billed charges,78% of total billed charges for outpatient setting,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,2.44,70,,1.952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.62,75,,2.096,percent of total billed charges,75% of total billed charges for outpatient setting,2.9,83,,2.32,percent of total billed charges,83% of total billed charges for outpatient setting,1.75,50,,1.4,percent of total billed charges,50% of total billed charges for outpatient setting,1.75,50,,1.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.37,39.17,,1.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.22,2.9,
LIDOCAINE W/EPI 50ML O/P CLINIC CHARGE,1688943,CDM,250,RC,,,outpatient,,,2.77,1.39,,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.06,38.4,,0.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.06,38.4,,0.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,2.08,75,,1.664,percent of total billed charges,75% of total billed charges for outpatient setting,2.08,75,,1.664,percent of total billed charges,75% of total billed charges for outpatient setting,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,2.08,75,,1.664,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.97,35,,0.776,percent of total billed charges,35% of total billed charges for outpatient setting,2.16,78,,1.728,percent of total billed charges,78% of total billed charges for outpatient setting,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,1.94,70,,1.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.08,75,,1.664,percent of total billed charges,75% of total billed charges for outpatient setting,2.3,83,,1.84,percent of total billed charges,83% of total billed charges for outpatient setting,1.39,50,,1.112,percent of total billed charges,50% of total billed charges for outpatient setting,1.39,50,,1.112,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.08,39.17,,0.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.97,2.3,
ASPIRIN EC 325 MG TAB EMS CHARGE ONLY,1688945,CDM,637,RC,,,outpatient,,,0.57,0.29,,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.22,38.4,,0.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.22,38.4,,0.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,0.43,75,,0.344,percent of total billed charges,75% of total billed charges for outpatient setting,0.43,75,,0.344,percent of total billed charges,75% of total billed charges for outpatient setting,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,0.43,75,,0.344,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.2,35,,0.16,percent of total billed charges,35% of total billed charges for outpatient setting,0.44,78,,0.352,percent of total billed charges,78% of total billed charges for outpatient setting,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,0.4,70,,0.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.43,75,,0.344,percent of total billed charges,75% of total billed charges for outpatient setting,0.47,83,,0.376,percent of total billed charges,83% of total billed charges for outpatient setting,0.29,50,,0.232,percent of total billed charges,50% of total billed charges for outpatient setting,0.29,50,,0.232,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.22,39.17,,0.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.2,0.47,
ATROPINE 8MG/20ML VL EMS CHARGE ONLY,1688946,CDM,250,RC,,,outpatient,,,29.11,14.56,,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.18,38.4,,8.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.18,38.4,,8.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,21.83,75,,17.464,percent of total billed charges,75% of total billed charges for outpatient setting,21.83,75,,17.464,percent of total billed charges,75% of total billed charges for outpatient setting,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,21.83,75,,17.464,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.19,35,,8.152,percent of total billed charges,35% of total billed charges for outpatient setting,22.71,78,,18.168,percent of total billed charges,78% of total billed charges for outpatient setting,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,20.38,70,,16.304,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.83,75,,17.464,percent of total billed charges,75% of total billed charges for outpatient setting,24.16,83,,19.328,percent of total billed charges,83% of total billed charges for outpatient setting,14.56,50,,11.648,percent of total billed charges,50% of total billed charges for outpatient setting,14.56,50,,11.648,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.4,39.17,,9.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.19,24.16,
BENADRYL 100MG/2ML VL EMS CHARGE ONLY,1688947,CDM,636,RC,J1200,HCPCS,both,,,0.7,0.35,,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.8,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,0.53,75,,0.424,percent of total billed charges,75% of total billed charges for outpatient setting,0.53,75,,0.424,percent of total billed charges,75% of total billed charges for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,0.53,75,,0.424,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.84,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,0.55,78,,0.44,percent of total billed charges,78% of total billed charges for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,0.49,70,,0.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.53,75,,0.424,percent of total billed charges,75% of total billed charges for outpatient setting,0.58,83,,0.464,percent of total billed charges,83% of total billed charges for outpatient setting,0.35,50,,0.28,percent of total billed charges,50% of total billed charges for outpatient setting,0.35,50,,0.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,0.84,
DEXTROSE 50% SYR EMS CHARGE ONLY,1688948,CDM,258,RC,,,outpatient,,,7.3,3.65,,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,38.4,,2.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,38.4,,2.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,5.48,75,,4.384,percent of total billed charges,75% of total billed charges for outpatient setting,5.48,75,,4.384,percent of total billed charges,75% of total billed charges for outpatient setting,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,5.48,75,,4.384,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.56,35,,2.048,percent of total billed charges,35% of total billed charges for outpatient setting,5.69,78,,4.552,percent of total billed charges,78% of total billed charges for outpatient setting,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,5.11,70,,4.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.48,75,,4.384,percent of total billed charges,75% of total billed charges for outpatient setting,6.06,83,,4.848,percent of total billed charges,83% of total billed charges for outpatient setting,3.65,50,,2.92,percent of total billed charges,50% of total billed charges for outpatient setting,3.65,50,,2.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.86,39.17,,2.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.56,6.06,
DOPamine/D5W 400MG/500ML EMS CHARGE ONLY,1688949,CDM,636,RC,J1265,HCPCS,both,,,11.5,5.75,,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.42,38.4,,3.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.42,38.4,,3.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.63,75,,6.904,percent of total billed charges,75% of total billed charges for outpatient setting,8.63,75,,6.904,percent of total billed charges,75% of total billed charges for outpatient setting,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.63,75,,6.904,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.03,35,,3.224,percent of total billed charges,35% of total billed charges for outpatient setting,8.97,78,,7.176,percent of total billed charges,78% of total billed charges for outpatient setting,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,8.05,70,,6.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.63,75,,6.904,percent of total billed charges,75% of total billed charges for outpatient setting,9.55,83,,7.64,percent of total billed charges,83% of total billed charges for outpatient setting,5.75,50,,4.6,percent of total billed charges,50% of total billed charges for outpatient setting,5.75,50,,4.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.51,39.17,,3.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.03,9.55,
DECADRON 4 MG VL EMS CHARGE ONLY,1688950,CDM,636,RC,J1100,HCPCS,both,,,0.73,0.37,,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.12,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,0.55,75,,0.44,percent of total billed charges,75% of total billed charges for outpatient setting,0.55,75,,0.44,percent of total billed charges,75% of total billed charges for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,0.55,75,,0.44,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.13,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,0.57,78,,0.456,percent of total billed charges,78% of total billed charges for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,0.51,70,,0.408,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.55,75,,0.44,percent of total billed charges,75% of total billed charges for outpatient setting,0.61,83,,0.488,percent of total billed charges,83% of total billed charges for outpatient setting,0.37,50,,0.296,percent of total billed charges,50% of total billed charges for outpatient setting,0.37,50,,0.296,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.12,0.61,
EPINEPHRINE 30MG/30ML EMS CHARGE ONLY,1688951,CDM,250,RC,,,outpatient,,,181.77,90.89,,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.8,38.4,,55.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.8,38.4,,55.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,136.33,75,,109.064,percent of total billed charges,75% of total billed charges for outpatient setting,136.33,75,,109.064,percent of total billed charges,75% of total billed charges for outpatient setting,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,136.33,75,,109.064,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.62,35,,50.896,percent of total billed charges,35% of total billed charges for outpatient setting,141.78,78,,113.424,percent of total billed charges,78% of total billed charges for outpatient setting,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,127.24,70,,101.792,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.33,75,,109.064,percent of total billed charges,75% of total billed charges for outpatient setting,150.87,83,,120.696,percent of total billed charges,83% of total billed charges for outpatient setting,90.89,50,,72.712,percent of total billed charges,50% of total billed charges for outpatient setting,90.89,50,,72.712,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.2,39.17,,56.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63.62,150.87,
EPINEPHRINE 1MG/ML AMP EMS CHARGE ONLY,1688952,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FLUMAZENIL VIAL 0.5MG/5ML EMS CHARGE,1688953,CDM,250,RC,,,outpatient,,,3.15,1.58,,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.21,38.4,,0.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.21,38.4,,0.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,2.36,75,,1.888,percent of total billed charges,75% of total billed charges for outpatient setting,2.36,75,,1.888,percent of total billed charges,75% of total billed charges for outpatient setting,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,2.36,75,,1.888,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.1,35,,0.88,percent of total billed charges,35% of total billed charges for outpatient setting,2.46,78,,1.968,percent of total billed charges,78% of total billed charges for outpatient setting,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,2.21,70,,1.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.36,75,,1.888,percent of total billed charges,75% of total billed charges for outpatient setting,2.61,83,,2.088,percent of total billed charges,83% of total billed charges for outpatient setting,1.58,50,,1.264,percent of total billed charges,50% of total billed charges for outpatient setting,1.58,50,,1.264,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.23,39.17,,0.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.1,2.61,
GLUCOSE GEL 24GM TUBE EMS CHARGE ONLY,1688954,CDM,637,RC,,,outpatient,,,2.9,1.45,,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.11,38.4,,0.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.11,38.4,,0.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,2.18,75,,1.744,percent of total billed charges,75% of total billed charges for outpatient setting,2.18,75,,1.744,percent of total billed charges,75% of total billed charges for outpatient setting,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,2.18,75,,1.744,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.02,35,,0.816,percent of total billed charges,35% of total billed charges for outpatient setting,2.26,78,,1.808,percent of total billed charges,78% of total billed charges for outpatient setting,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,2.03,70,,1.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.18,75,,1.744,percent of total billed charges,75% of total billed charges for outpatient setting,2.41,83,,1.928,percent of total billed charges,83% of total billed charges for outpatient setting,1.45,50,,1.16,percent of total billed charges,50% of total billed charges for outpatient setting,1.45,50,,1.16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.13,39.17,,0.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.02,2.41,
GLUCAGON 1 MG KIT EMS CHARGE ONLY,1688955,CDM,636,RC,J1610,HCPCS,both,,,268.64,134.32,,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,188.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,188.37,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,201.48,75,,161.184,percent of total billed charges,75% of total billed charges for outpatient setting,201.48,75,,161.184,percent of total billed charges,75% of total billed charges for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,201.48,75,,161.184,percent of total billed charges,75% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.79,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,209.54,78,,167.632,percent of total billed charges,78% of total billed charges for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,188.05,70,,150.44,percent of total billed charges,70% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.48,75,,161.184,percent of total billed charges,75% of total billed charges for outpatient setting,222.97,83,,178.376,percent of total billed charges,83% of total billed charges for outpatient setting,134.32,50,,107.456,percent of total billed charges,50% of total billed charges for outpatient setting,134.32,50,,107.456,percent of total billed charges,50% of total billed charges for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,188.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,188.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.32,222.97,
LABETALOL 100MG/20ML VL EMS CHARGE ONLY,1688956,CDM,250,RC,,,outpatient,,,3.09,1.55,,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.19,38.4,,0.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.19,38.4,,0.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,2.32,75,,1.856,percent of total billed charges,75% of total billed charges for outpatient setting,2.32,75,,1.856,percent of total billed charges,75% of total billed charges for outpatient setting,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,2.32,75,,1.856,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.08,35,,0.864,percent of total billed charges,35% of total billed charges for outpatient setting,2.41,78,,1.928,percent of total billed charges,78% of total billed charges for outpatient setting,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,2.16,70,,1.728,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.32,75,,1.856,percent of total billed charges,75% of total billed charges for outpatient setting,2.56,83,,2.048,percent of total billed charges,83% of total billed charges for outpatient setting,1.55,50,,1.24,percent of total billed charges,50% of total billed charges for outpatient setting,1.55,50,,1.24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.21,39.17,,0.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.08,2.56,
FUROSEMIDE 100MG/10ML VL EMS CHARGE ONLY,1688957,CDM,636,RC,J1940,HCPCS,both,,,5.5,2.75,,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.57,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,4.13,75,,3.304,percent of total billed charges,75% of total billed charges for outpatient setting,4.13,75,,3.304,percent of total billed charges,75% of total billed charges for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,4.13,75,,3.304,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.6,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.29,78,,3.432,percent of total billed charges,78% of total billed charges for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,3.85,70,,3.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.13,75,,3.304,percent of total billed charges,75% of total billed charges for outpatient setting,4.57,83,,3.656,percent of total billed charges,83% of total billed charges for outpatient setting,2.75,50,,2.2,percent of total billed charges,50% of total billed charges for outpatient setting,2.75,50,,2.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,4.57,
LIDOCAINE 100MG/5ML PFS EMS CHARGE ONLY,1688958,CDM,250,RC,,,outpatient,,,2.43,1.22,,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.93,38.4,,0.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.93,38.4,,0.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,1.82,75,,1.456,percent of total billed charges,75% of total billed charges for outpatient setting,1.82,75,,1.456,percent of total billed charges,75% of total billed charges for outpatient setting,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,1.82,75,,1.456,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.85,35,,0.68,percent of total billed charges,35% of total billed charges for outpatient setting,1.9,78,,1.52,percent of total billed charges,78% of total billed charges for outpatient setting,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,1.7,70,,1.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.82,75,,1.456,percent of total billed charges,75% of total billed charges for outpatient setting,2.02,83,,1.616,percent of total billed charges,83% of total billed charges for outpatient setting,1.22,50,,0.976,percent of total billed charges,50% of total billed charges for outpatient setting,1.22,50,,0.976,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.95,39.17,,0.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.85,2.02,
LIDOCAINE/D5W PREMIX IV BAG EMS CHARGE,1688959,CDM,250,RC,,,outpatient,,,3.75,1.88,,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.44,38.4,,1.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.44,38.4,,1.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,2.81,75,,2.248,percent of total billed charges,75% of total billed charges for outpatient setting,2.81,75,,2.248,percent of total billed charges,75% of total billed charges for outpatient setting,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,2.81,75,,2.248,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.31,35,,1.048,percent of total billed charges,35% of total billed charges for outpatient setting,2.93,78,,2.344,percent of total billed charges,78% of total billed charges for outpatient setting,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,2.63,70,,2.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.81,75,,2.248,percent of total billed charges,75% of total billed charges for outpatient setting,3.11,83,,2.488,percent of total billed charges,83% of total billed charges for outpatient setting,1.88,50,,1.504,percent of total billed charges,50% of total billed charges for outpatient setting,1.88,50,,1.504,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.47,39.17,,1.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.31,3.11,
MAGNESIUM SULF 50% SYR EMS CHARGE ONLY,1688960,CDM,250,RC,J3475,HCPCS,outpatient,,,15.07,7.54,,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,11.3,75,,9.04,percent of total billed charges,75% of total billed charges for outpatient setting,11.3,75,,9.04,percent of total billed charges,75% of total billed charges for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,11.3,75,,9.04,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,11.75,78,,9.4,percent of total billed charges,78% of total billed charges for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,10.55,70,,8.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.3,75,,9.04,percent of total billed charges,75% of total billed charges for outpatient setting,12.51,83,,10.008,percent of total billed charges,83% of total billed charges for outpatient setting,7.54,50,,6.032,percent of total billed charges,50% of total billed charges for outpatient setting,7.54,50,,6.032,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.69,12.51,
NALOXONE 0.4 MG VL EMS CHARGE ONLY,1688961,CDM,636,RC,J2310,HCPCS,both,,,12.82,6.41,,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.29,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,9.62,75,,7.696,percent of total billed charges,75% of total billed charges for outpatient setting,9.62,75,,7.696,percent of total billed charges,75% of total billed charges for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,9.62,75,,7.696,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.65,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,10,78,,8,percent of total billed charges,78% of total billed charges for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,8.97,70,,7.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.62,75,,7.696,percent of total billed charges,75% of total billed charges for outpatient setting,10.64,83,,8.512,percent of total billed charges,83% of total billed charges for outpatient setting,6.41,50,,5.128,percent of total billed charges,50% of total billed charges for outpatient setting,6.41,50,,5.128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.29,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.41,10.64,
NITROGLYCERIN 0.4MG TAB EMS CHARGE ONLY,1688963,CDM,637,RC,,,outpatient,,,19.51,9.76,,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.49,38.4,,5.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.49,38.4,,5.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,14.63,75,,11.704,percent of total billed charges,75% of total billed charges for outpatient setting,14.63,75,,11.704,percent of total billed charges,75% of total billed charges for outpatient setting,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,14.63,75,,11.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.83,35,,5.464,percent of total billed charges,35% of total billed charges for outpatient setting,15.22,78,,12.176,percent of total billed charges,78% of total billed charges for outpatient setting,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,13.66,70,,10.928,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.63,75,,11.704,percent of total billed charges,75% of total billed charges for outpatient setting,16.19,83,,12.952,percent of total billed charges,83% of total billed charges for outpatient setting,9.76,50,,7.808,percent of total billed charges,50% of total billed charges for outpatient setting,9.76,50,,7.808,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.64,39.17,,6.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.83,16.19,
ONDANSETRON (ZOFRAN) 4 MG VL EMS CHARGE,1688965,CDM,636,RC,J2405,HCPCS,both,,,1.14,0.57,,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.1,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,0.86,75,,0.688,percent of total billed charges,75% of total billed charges for outpatient setting,0.86,75,,0.688,percent of total billed charges,75% of total billed charges for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,0.86,75,,0.688,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.11,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,0.89,78,,0.712,percent of total billed charges,78% of total billed charges for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,0.8,70,,0.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.86,75,,0.688,percent of total billed charges,75% of total billed charges for outpatient setting,0.95,83,,0.76,percent of total billed charges,83% of total billed charges for outpatient setting,0.57,50,,0.456,percent of total billed charges,50% of total billed charges for outpatient setting,0.57,50,,0.456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.1,0.95,
OXYTOCIN (PITOCIN) 10U VL EMS CHARGE,1688966,CDM,250,RC,,,outpatient,,,1.39,0.7,,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.53,38.4,,0.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.53,38.4,,0.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,1.04,75,,0.832,percent of total billed charges,75% of total billed charges for outpatient setting,1.04,75,,0.832,percent of total billed charges,75% of total billed charges for outpatient setting,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,1.04,75,,0.832,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,35,,0.392,percent of total billed charges,35% of total billed charges for outpatient setting,1.08,78,,0.864,percent of total billed charges,78% of total billed charges for outpatient setting,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,0.97,70,,0.776,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.04,75,,0.832,percent of total billed charges,75% of total billed charges for outpatient setting,1.15,83,,0.92,percent of total billed charges,83% of total billed charges for outpatient setting,0.7,50,,0.56,percent of total billed charges,50% of total billed charges for outpatient setting,0.7,50,,0.56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.54,39.17,,0.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.49,1.15,
TERBUTALINE1MG/1ML INJ EMS CHARGE ONLY,1688967,CDM,250,RC,,,outpatient,,,1.09,0.55,,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.42,38.4,,0.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.42,38.4,,0.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,0.82,75,,0.656,percent of total billed charges,75% of total billed charges for outpatient setting,0.82,75,,0.656,percent of total billed charges,75% of total billed charges for outpatient setting,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,0.82,75,,0.656,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,35,,0.304,percent of total billed charges,35% of total billed charges for outpatient setting,0.85,78,,0.68,percent of total billed charges,78% of total billed charges for outpatient setting,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,0.76,70,,0.608,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.82,75,,0.656,percent of total billed charges,75% of total billed charges for outpatient setting,0.9,83,,0.72,percent of total billed charges,83% of total billed charges for outpatient setting,0.55,50,,0.44,percent of total billed charges,50% of total billed charges for outpatient setting,0.55,50,,0.44,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.43,39.17,,0.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.38,0.9,
SODIUM BICARB 8.4% PFS 50ML EMS CHARGE,1688968,CDM,250,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
SOLU-MEDROL 125MG/2ML EMS CHARGE ONLY,1688969,CDM,636,RC,J2930,HCPCS,both,,,7.41,3.71,,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,75,,4.448,percent of total billed charges,75% of total billed charges for outpatient setting,5.56,75,,4.448,percent of total billed charges,75% of total billed charges for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,5.56,75,,4.448,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.78,78,,4.624,percent of total billed charges,78% of total billed charges for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,5.19,70,,4.152,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.56,75,,4.448,percent of total billed charges,75% of total billed charges for outpatient setting,6.15,83,,4.92,percent of total billed charges,83% of total billed charges for outpatient setting,3.71,50,,2.968,percent of total billed charges,50% of total billed charges for outpatient setting,3.71,50,,2.968,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.71,6.17,
THIAMINE 100 MG/ML VL EMS CHARGE ONLY,1688970,CDM,250,RC,,,outpatient,,,5.36,2.68,,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.06,38.4,,1.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.06,38.4,,1.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,4.02,75,,3.216,percent of total billed charges,75% of total billed charges for outpatient setting,4.02,75,,3.216,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,4.02,75,,3.216,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.88,35,,1.504,percent of total billed charges,35% of total billed charges for outpatient setting,4.18,78,,3.344,percent of total billed charges,78% of total billed charges for outpatient setting,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,70,,3,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.02,75,,3.216,percent of total billed charges,75% of total billed charges for outpatient setting,4.45,83,,3.56,percent of total billed charges,83% of total billed charges for outpatient setting,2.68,50,,2.144,percent of total billed charges,50% of total billed charges for outpatient setting,2.68,50,,2.144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,39.17,,1.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.88,4.45,
KETOROLAC (TORADOL) 60MG VL EMS CHARGE,1688971,CDM,636,RC,J1885,HCPCS,both,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.49,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,0.83,
VERAPAMIL 5MG/2ML EMS CHARGE ONLY,1688972,CDM,250,RC,,,outpatient,,,14.98,7.49,,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.75,38.4,,4.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.75,38.4,,4.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,11.24,75,,8.992,percent of total billed charges,75% of total billed charges for outpatient setting,11.24,75,,8.992,percent of total billed charges,75% of total billed charges for outpatient setting,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,11.24,75,,8.992,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.24,35,,4.192,percent of total billed charges,35% of total billed charges for outpatient setting,11.68,78,,9.344,percent of total billed charges,78% of total billed charges for outpatient setting,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,10.49,70,,8.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.24,75,,8.992,percent of total billed charges,75% of total billed charges for outpatient setting,12.43,83,,9.944,percent of total billed charges,83% of total billed charges for outpatient setting,7.49,50,,5.992,percent of total billed charges,50% of total billed charges for outpatient setting,7.49,50,,5.992,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.87,39.17,,4.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.24,12.43,
SODIUM CHL 0.9% 10ML VL EMS CHARGE ONLY,1688973,CDM,250,RC,,,outpatient,,,0.65,0.33,,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.25,38.4,,0.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.25,38.4,,0.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,0.49,75,,0.392,percent of total billed charges,75% of total billed charges for outpatient setting,0.49,75,,0.392,percent of total billed charges,75% of total billed charges for outpatient setting,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,0.49,75,,0.392,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.23,35,,0.184,percent of total billed charges,35% of total billed charges for outpatient setting,0.51,78,,0.408,percent of total billed charges,78% of total billed charges for outpatient setting,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,0.46,70,,0.368,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.49,75,,0.392,percent of total billed charges,75% of total billed charges for outpatient setting,0.54,83,,0.432,percent of total billed charges,83% of total billed charges for outpatient setting,0.33,50,,0.264,percent of total billed charges,50% of total billed charges for outpatient setting,0.33,50,,0.264,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.26,39.17,,0.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.23,0.54,
D10W 1000ML IV BAG EMS CHARGE ONLY,1688974,CDM,250,RC,,,outpatient,,,3.03,1.52,,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.16,38.4,,0.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.16,38.4,,0.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,2.27,75,,1.816,percent of total billed charges,75% of total billed charges for outpatient setting,2.27,75,,1.816,percent of total billed charges,75% of total billed charges for outpatient setting,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,2.27,75,,1.816,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.06,35,,0.848,percent of total billed charges,35% of total billed charges for outpatient setting,2.36,78,,1.888,percent of total billed charges,78% of total billed charges for outpatient setting,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,2.12,70,,1.696,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.27,75,,1.816,percent of total billed charges,75% of total billed charges for outpatient setting,2.51,83,,2.008,percent of total billed charges,83% of total billed charges for outpatient setting,1.52,50,,1.216,percent of total billed charges,50% of total billed charges for outpatient setting,1.52,50,,1.216,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.18,39.17,,0.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.06,2.51,
RAPID SEQUENCE INTUBATION KIT,1688976,CDM,250,RC,,,outpatient,,,335,167.5,,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.64,38.4,,102.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.64,38.4,,102.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,251.25,75,,201,percent of total billed charges,75% of total billed charges for outpatient setting,251.25,75,,201,percent of total billed charges,75% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,251.25,75,,201,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.25,35,,93.8,percent of total billed charges,35% of total billed charges for outpatient setting,261.3,78,,209.04,percent of total billed charges,78% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,234.5,70,,187.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,251.25,75,,201,percent of total billed charges,75% of total billed charges for outpatient setting,278.05,83,,222.44,percent of total billed charges,83% of total billed charges for outpatient setting,167.5,50,,134,percent of total billed charges,50% of total billed charges for outpatient setting,167.5,50,,134,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.21,39.17,,104.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,117.25,278.05,
NORMAL SALINE 500ML BAG EMS CHARGE ONLY,1688977,CDM,636,RC,J7040,HCPCS,both,,,1.85,0.93,,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,1.39,75,,1.112,percent of total billed charges,75% of total billed charges for outpatient setting,1.39,75,,1.112,percent of total billed charges,75% of total billed charges for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,1.39,75,,1.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1.44,78,,1.152,percent of total billed charges,78% of total billed charges for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,1.3,70,,1.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.39,75,,1.112,percent of total billed charges,75% of total billed charges for outpatient setting,1.54,83,,1.232,percent of total billed charges,83% of total billed charges for outpatient setting,0.93,50,,0.744,percent of total billed charges,50% of total billed charges for outpatient setting,0.93,50,,0.744,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.93,1.54,
XOPENEX 0.63MG/3ML  EMS CHARGE ONLY,1688978,CDM,637,RC,,,outpatient,,,1.46,0.73,,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.56,38.4,,0.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.56,38.4,,0.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,1.1,75,,0.88,percent of total billed charges,75% of total billed charges for outpatient setting,1.1,75,,0.88,percent of total billed charges,75% of total billed charges for outpatient setting,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,1.1,75,,0.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.51,35,,0.408,percent of total billed charges,35% of total billed charges for outpatient setting,1.14,78,,0.912,percent of total billed charges,78% of total billed charges for outpatient setting,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,1.02,70,,0.816,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.1,75,,0.88,percent of total billed charges,75% of total billed charges for outpatient setting,1.21,83,,0.968,percent of total billed charges,83% of total billed charges for outpatient setting,0.73,50,,0.584,percent of total billed charges,50% of total billed charges for outpatient setting,0.73,50,,0.584,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.57,39.17,,0.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.51,1.21,
KETAMINE 500 MG VL EMS CHARGE ONLY,1688979,CDM,250,RC,,,outpatient,,,8.18,4.09,,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.14,38.4,,2.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.14,38.4,,2.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,75,,4.912,percent of total billed charges,75% of total billed charges for outpatient setting,6.14,75,,4.912,percent of total billed charges,75% of total billed charges for outpatient setting,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,6.14,75,,4.912,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.86,35,,2.288,percent of total billed charges,35% of total billed charges for outpatient setting,6.38,78,,5.104,percent of total billed charges,78% of total billed charges for outpatient setting,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,5.73,70,,4.584,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,75,,4.912,percent of total billed charges,75% of total billed charges for outpatient setting,6.79,83,,5.432,percent of total billed charges,83% of total billed charges for outpatient setting,4.09,50,,3.272,percent of total billed charges,50% of total billed charges for outpatient setting,4.09,50,,3.272,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.2,39.17,,2.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.86,6.79,
MORPHINE 2 MG INJ EMS CHARGE ONLY,1688980,CDM,636,RC,J2270,HCPCS,both,,,1.8,0.9,,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1.4,78,,1.12,percent of total billed charges,78% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.49,83,,1.192,percent of total billed charges,83% of total billed charges for outpatient setting,0.9,50,,0.72,percent of total billed charges,50% of total billed charges for outpatient setting,0.9,50,,0.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.9,4.9,
MEPERIDINE (DEMEROL) 50MG VL EMS CHARGE,1688981,CDM,636,RC,J2175,HCPCS,both,,,3.33,1.67,,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,2.5,75,,2,percent of total billed charges,75% of total billed charges for outpatient setting,2.5,75,,2,percent of total billed charges,75% of total billed charges for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,2.5,75,,2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,2.6,78,,2.08,percent of total billed charges,78% of total billed charges for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,2.33,70,,1.864,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.5,75,,2,percent of total billed charges,75% of total billed charges for outpatient setting,2.76,83,,2.208,percent of total billed charges,83% of total billed charges for outpatient setting,1.67,50,,1.336,percent of total billed charges,50% of total billed charges for outpatient setting,1.67,50,,1.336,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.67,7.67,
VERSED 5MG VL EMS CHARGE ONLY,1688982,CDM,636,RC,J2250,HCPCS,both,,,0.31,0.16,,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.14,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,0.23,75,,0.184,percent of total billed charges,75% of total billed charges for outpatient setting,0.23,75,,0.184,percent of total billed charges,75% of total billed charges for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,0.23,75,,0.184,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,0.24,78,,0.192,percent of total billed charges,78% of total billed charges for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,0.22,70,,0.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.23,75,,0.184,percent of total billed charges,75% of total billed charges for outpatient setting,0.26,83,,0.208,percent of total billed charges,83% of total billed charges for outpatient setting,0.16,50,,0.128,percent of total billed charges,50% of total billed charges for outpatient setting,0.16,50,,0.128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.14,0.26,
MORPHINE 4 MG/1ML INJ EMS CHARGE ONLY,1689000,CDM,636,RC,J2270,HCPCS,both,,,1.8,0.9,,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.67,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1.4,78,,1.12,percent of total billed charges,78% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,1.26,70,,1.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,75,,1.08,percent of total billed charges,75% of total billed charges for outpatient setting,1.49,83,,1.192,percent of total billed charges,83% of total billed charges for outpatient setting,0.9,50,,0.72,percent of total billed charges,50% of total billed charges for outpatient setting,0.9,50,,0.72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.67,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.9,4.9,
SEVOFLURANE (ULTANE) ANESTHESA GAS,1689011,CDM,250,RC,,,outpatient,,,96.6,48.3,,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.09,38.4,,29.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.09,38.4,,29.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.81,35,,27.048,percent of total billed charges,35% of total billed charges for outpatient setting,75.35,78,,60.28,percent of total billed charges,78% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,80.18,83,,64.144,percent of total billed charges,83% of total billed charges for outpatient setting,48.3,50,,38.64,percent of total billed charges,50% of total billed charges for outpatient setting,48.3,50,,38.64,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.83,39.17,,30.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.81,80.18,
JUST LIKE TEMPLATE   PHARMACY (78 / 250),1689018,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HYDROGEN PEROXIDE 236 ML BOTTLE,1689019,CDM,636,RC,A4244,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LABETALOL (TRANDATE) 20MG/4ML CARPUJECT,1689039,CDM,250,RC,,,outpatient,,,19.41,9.71,,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.45,38.4,,5.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.79,35,,5.432,percent of total billed charges,35% of total billed charges for outpatient setting,15.14,78,,12.112,percent of total billed charges,78% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,13.59,70,,10.872,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.56,75,,11.648,percent of total billed charges,75% of total billed charges for outpatient setting,16.11,83,,12.888,percent of total billed charges,83% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,9.71,50,,7.768,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.6,39.17,,6.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.79,16.11,
PATIROMER (VELTASSA) 8.4G ORAL SUSP PKT,1689045,CDM,637,RC,,,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,107.07,
SACUBITRIL/VALSARTAN (ENTRESTO) 24/26,1689057,CDM,637,RC,,,outpatient,,,37.8,18.9,,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.52,38.4,,11.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.52,38.4,,11.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,28.35,75,,22.68,percent of total billed charges,75% of total billed charges for outpatient setting,28.35,75,,22.68,percent of total billed charges,75% of total billed charges for outpatient setting,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,28.35,75,,22.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.23,35,,10.584,percent of total billed charges,35% of total billed charges for outpatient setting,29.48,78,,23.584,percent of total billed charges,78% of total billed charges for outpatient setting,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,26.46,70,,21.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.35,75,,22.68,percent of total billed charges,75% of total billed charges for outpatient setting,31.37,83,,25.096,percent of total billed charges,83% of total billed charges for outpatient setting,18.9,50,,15.12,percent of total billed charges,50% of total billed charges for outpatient setting,18.9,50,,15.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.81,39.17,,11.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.23,31.37,
FERROUS SULFATE 300MG/5ML ORAL SOLUTION,1689099,CDM,637,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
VANCOMYCIN 1500 MG VIAL INJ,1689120,CDM,636,RC,,,both,,,71.74,35.87,,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.55,38.4,,22.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.55,38.4,,22.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,53.81,75,,43.048,percent of total billed charges,75% of total billed charges for outpatient setting,53.81,75,,43.048,percent of total billed charges,75% of total billed charges for outpatient setting,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,53.81,75,,43.048,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.11,35,,20.088,percent of total billed charges,35% of total billed charges for outpatient setting,55.96,78,,44.768,percent of total billed charges,78% of total billed charges for outpatient setting,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,50.22,70,,40.176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.81,75,,43.048,percent of total billed charges,75% of total billed charges for outpatient setting,59.54,83,,47.632,percent of total billed charges,83% of total billed charges for outpatient setting,35.87,50,,28.696,percent of total billed charges,50% of total billed charges for outpatient setting,35.87,50,,28.696,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.1,39.17,,22.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.11,59.54,
VANCOMYCIN 1250 MG VIAL INJ,1689126,CDM,636,RC,,,both,,,59.92,29.96,,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.01,38.4,,18.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.01,38.4,,18.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,44.94,75,,35.952,percent of total billed charges,75% of total billed charges for outpatient setting,44.94,75,,35.952,percent of total billed charges,75% of total billed charges for outpatient setting,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,44.94,75,,35.952,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.97,35,,16.776,percent of total billed charges,35% of total billed charges for outpatient setting,46.74,78,,37.392,percent of total billed charges,78% of total billed charges for outpatient setting,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,41.94,70,,33.552,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.94,75,,35.952,percent of total billed charges,75% of total billed charges for outpatient setting,49.73,83,,39.784,percent of total billed charges,83% of total billed charges for outpatient setting,29.96,50,,23.968,percent of total billed charges,50% of total billed charges for outpatient setting,29.96,50,,23.968,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.47,39.17,,18.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.97,49.73,
KETAMINE (KETALAR) 30MG/3ML SYR,1689190,CDM,250,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
JUST LIKE TEMPLATE DETAILED DRUGS (AN),1689208,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DESFLURANE (SUPRANE) 1/4 BOTTLE,1689209,CDM,636,RC,,,both,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.2,109.56,
MEPERIDINE (DEMEROL) 25MG INJECTION,1689253,CDM,636,RC,J2175,HCPCS,both,,,11.2,5.6,,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,8.74,78,,6.992,percent of total billed charges,78% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,7.84,70,,6.272,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,75,,6.72,percent of total billed charges,75% of total billed charges for outpatient setting,9.3,83,,7.44,percent of total billed charges,83% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,5.6,50,,4.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,9.3,
ORITAVANCIN (ORBACTIV) 400MG VIAL INJ,1689280,CDM,636,RC,J2407,HCPCS,both,,,3444,1722,,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,27.6,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,27.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,27.6,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.98,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,2686.32,78,,2149.056,percent of total billed charges,78% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2858.52,83,,2286.816,percent of total billed charges,83% of total billed charges for outpatient setting,1722,50,,1377.6,percent of total billed charges,50% of total billed charges for outpatient setting,1722,50,,1377.6,percent of total billed charges,50% of total billed charges for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,27.6,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.6,2858.52,
SODIUM CHLORIDE 0.9% IRRIGATION 3L BAG,1689313,CDM,258,RC,,,outpatient,,,28.7,14.35,,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.02,38.4,,8.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.02,38.4,,8.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.05,35,,8.04,percent of total billed charges,35% of total billed charges for outpatient setting,22.39,78,,17.912,percent of total billed charges,78% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,20.09,70,,16.072,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.53,75,,17.224,percent of total billed charges,75% of total billed charges for outpatient setting,23.82,83,,19.056,percent of total billed charges,83% of total billed charges for outpatient setting,14.35,50,,11.48,percent of total billed charges,50% of total billed charges for outpatient setting,14.35,50,,11.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.24,39.17,,8.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.05,23.82,
SOTALOL (BETAPACE) 150MG / 10ML VIAL,1689316,CDM,636,RC,,,both,,,7622,3811,,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2926.85,38.4,,2341.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2926.85,38.4,,2341.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,5716.5,75,,4573.2,percent of total billed charges,75% of total billed charges for outpatient setting,5716.5,75,,4573.2,percent of total billed charges,75% of total billed charges for outpatient setting,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,5716.5,75,,4573.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2667.7,35,,2134.16,percent of total billed charges,35% of total billed charges for outpatient setting,5945.16,78,,4756.128,percent of total billed charges,78% of total billed charges for outpatient setting,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,5335.4,70,,4268.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5716.5,75,,4573.2,percent of total billed charges,75% of total billed charges for outpatient setting,6326.26,83,,5061.008,percent of total billed charges,83% of total billed charges for outpatient setting,3811,50,,3048.8,percent of total billed charges,50% of total billed charges for outpatient setting,3811,50,,3048.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2985.39,39.17,,2388.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2667.7,6326.26,
ADENOSINE (ADENOCARD) 12MG/4ML FOR EMS,1689357,CDM,636,RC,,,both,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
DALBAVANCIN (DALVANCE) 500MG VIAL,1689371,CDM,636,RC,,,both,,,5607,2803.5,,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2153.09,38.4,,1722.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2153.09,38.4,,1722.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,4205.25,75,,3364.2,percent of total billed charges,75% of total billed charges for outpatient setting,4205.25,75,,3364.2,percent of total billed charges,75% of total billed charges for outpatient setting,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,4205.25,75,,3364.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1962.45,35,,1569.96,percent of total billed charges,35% of total billed charges for outpatient setting,4373.46,78,,3498.768,percent of total billed charges,78% of total billed charges for outpatient setting,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,3924.9,70,,3139.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4205.25,75,,3364.2,percent of total billed charges,75% of total billed charges for outpatient setting,4653.81,83,,3723.048,percent of total billed charges,83% of total billed charges for outpatient setting,2803.5,50,,2242.8,percent of total billed charges,50% of total billed charges for outpatient setting,2803.5,50,,2242.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2196.15,39.17,,1756.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1962.45,4653.81,
LACOSAMIDE (VIMPAT) 50MG TAB,1689435,CDM,636,RC,,,both,,,36,18,,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.82,38.4,,11.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.82,38.4,,11.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.6,35,,10.08,percent of total billed charges,35% of total billed charges for outpatient setting,28.08,78,,22.464,percent of total billed charges,78% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,25.2,70,,20.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27,75,,21.6,percent of total billed charges,75% of total billed charges for outpatient setting,29.88,83,,23.904,percent of total billed charges,83% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,18,50,,14.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.1,39.17,,11.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.6,29.88,
GI COCKTAIL 35ML KIT,1689445,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
OLANZAPINE (ZYPREXA) 10MG IM INJECTION,1689494,CDM,636,RC,,,both,,,161,80.5,,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.82,38.4,,49.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.82,38.4,,49.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.35,35,,45.08,percent of total billed charges,35% of total billed charges for outpatient setting,125.58,78,,100.464,percent of total billed charges,78% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,112.7,70,,90.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,75,,96.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.63,83,,106.904,percent of total billed charges,83% of total billed charges for outpatient setting,80.5,50,,64.4,percent of total billed charges,50% of total billed charges for outpatient setting,80.5,50,,64.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.06,39.17,,50.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56.35,133.63,
FAMOTIDINE (PEPCID) 20MG TAB,1689526,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
LIDOCAINE / EPI (XYLOCAINE/EPI) 2% 10ML,1689531,CDM,636,RC,,,both,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
OCTREOTIDE (SANDOSTATIN) 1000MCG VIAL,1689560,CDM,636,RC,,,both,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.65,35,,27.72,percent of total billed charges,35% of total billed charges for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,49.5,50,,39.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.78,39.17,,31.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.65,82.17,
MELATONIN 5MG TABLET,1689569,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
REMDESIVIR 100 MG VIAL,1689570,CDM,636,RC,J0248,HCPCS,both,,,1924,962,,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,1443,75,,1154.4,percent of total billed charges,75% of total billed charges for outpatient setting,1443,75,,1154.4,percent of total billed charges,75% of total billed charges for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,1443,75,,1154.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,1500.72,78,,1200.576,percent of total billed charges,78% of total billed charges for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,1346.8,70,,1077.44,percent of total billed charges,70% of total billed charges for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1443,75,,1154.4,percent of total billed charges,75% of total billed charges for outpatient setting,1596.92,83,,1277.536,percent of total billed charges,83% of total billed charges for outpatient setting,962,50,,769.6,percent of total billed charges,50% of total billed charges for outpatient setting,962,50,,769.6,percent of total billed charges,50% of total billed charges for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,1596.92,
REMDESIVIR 200MG / 250 ML NS FIRST DOSE,1689571,CDM,258,RC,J0248,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,6.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,6.36,
REMDESIVIR 100MG / 100 ML NS DOSES 2-5,1689572,CDM,258,RC,J0248,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,6.06,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.36,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,6.06,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.06,6.36,
NICARDIPINE (CARDENE) 20 MG / 200 ML BAG,1689600,CDM,636,RC,J3490,HCPCS,both,,,157,78.5,,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.29,38.4,,48.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.29,38.4,,48.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,117.75,75,,94.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.75,75,,94.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,117.75,75,,94.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.95,35,,43.96,percent of total billed charges,35% of total billed charges for outpatient setting,122.46,78,,97.968,percent of total billed charges,78% of total billed charges for outpatient setting,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,109.9,70,,87.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.75,75,,94.2,percent of total billed charges,75% of total billed charges for outpatient setting,130.31,83,,104.248,percent of total billed charges,83% of total billed charges for outpatient setting,78.5,50,,62.8,percent of total billed charges,50% of total billed charges for outpatient setting,78.5,50,,62.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.5,39.17,,49.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.95,130.31,
DEXMEDETOMIDINE (PRECEDEX) 200MCG/2ML,1689601,CDM,636,RC,J8540,HCPCS,both,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
ISOFLURANE (FORANE) INH DOSE,1689636,CDM,636,RC,,,both,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
DIGOXIN IMMUNE FAB (DIGIFAB) 40MG VIAL,1689651,CDM,636,RC,,,both,,,13935,6967.5,,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5351.04,38.4,,4280.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5351.04,38.4,,4280.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,10451.25,75,,8361,percent of total billed charges,75% of total billed charges for outpatient setting,10451.25,75,,8361,percent of total billed charges,75% of total billed charges for outpatient setting,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,10451.25,75,,8361,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4877.25,35,,3901.8,percent of total billed charges,35% of total billed charges for outpatient setting,10869.3,78,,8695.44,percent of total billed charges,78% of total billed charges for outpatient setting,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,9754.5,70,,7803.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10451.25,75,,8361,percent of total billed charges,75% of total billed charges for outpatient setting,11566.05,83,,9252.84,percent of total billed charges,83% of total billed charges for outpatient setting,6967.5,50,,5574,percent of total billed charges,50% of total billed charges for outpatient setting,6967.5,50,,5574,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5458.06,39.17,,4366.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4877.25,11566.05,
LIDOCAINE 1% / EPI (XYLOCAINE) 20ML VIAL,1689677,CDM,636,RC,J2001,HCPCS,both,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,5.81,
ERTAPENEM (INVANZ) 1GRAM VIAL IV OR IM,1689720,CDM,636,RC,J1335,HCPCS,both,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12.97,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.62,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.97,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.97,81.34,
CASIRIVIMAB & IMDEVIMAB (REGEN-COV) 10ML,1689766,CDM,636,RC,,,both,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,0.01,50,,0.008,percent of total billed charges,50% of total billed charges for outpatient setting,0.01,50,,0.008,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,0.01,
IVERMECTIN (STROMECTOL) 3 MG TAB,1689774,CDM,636,RC,,,both,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
COPPER CHLORIDE 4MG/10ML VIAL,1689781,CDM,636,RC,,,both,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.5,58.1,
ROPIVACAINE 0.5% (NAROPIN) 100MG / 20ML,1689789,CDM,636,RC,J2795,HCPCS,both,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
ROPIVACAINE 0.2% (NAROPIN) 40MG / 20 ML,1689798,CDM,636,RC,,,both,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
FLUVOXAMINE (LUVOX) 50 MG TABS,1689826,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SILDENAFIL 20 MG TAB,1689829,CDM,250,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SUGAMMADEX (BRIDION) 200MG / 2ML VIAL,1689839,CDM,636,RC,J3490,HCPCS,both,,,402,201,,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,154.37,38.4,,123.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,154.37,38.4,,123.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,140.7,35,,112.56,percent of total billed charges,35% of total billed charges for outpatient setting,313.56,78,,250.848,percent of total billed charges,78% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,333.66,83,,266.928,percent of total billed charges,83% of total billed charges for outpatient setting,201,50,,160.8,percent of total billed charges,50% of total billed charges for outpatient setting,201,50,,160.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.46,39.17,,125.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,140.7,333.66,
NIFEDIPINE 10MG CAPSULE,1689860,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ESMOLOL (BREVIBLOC) 2500MG / 250ML BAG,1689861,CDM,637,RC,,,outpatient,,,410,205,,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.44,38.4,,125.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.5,35,,114.8,percent of total billed charges,35% of total billed charges for outpatient setting,319.8,78,,255.84,percent of total billed charges,78% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,287,70,,229.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,307.5,75,,246,percent of total billed charges,75% of total billed charges for outpatient setting,340.3,83,,272.24,percent of total billed charges,83% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,205,50,,164,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.59,39.17,,128.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,143.5,340.3,
METHYLERGONOVINE (METHERGINE) 0.2MG/ML,1689862,CDM,636,RC,,,both,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.8,73.04,
HEP B IMMUNE GLOBULIN (NABI-HB) 312U/ML,1689910,CDM,636,RC,,,both,,,2047,1023.5,,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,786.05,38.4,,628.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,786.05,38.4,,628.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.45,35,,573.16,percent of total billed charges,35% of total billed charges for outpatient setting,1596.66,78,,1277.328,percent of total billed charges,78% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1699.01,83,,1359.208,percent of total billed charges,83% of total billed charges for outpatient setting,1023.5,50,,818.8,percent of total billed charges,50% of total billed charges for outpatient setting,1023.5,50,,818.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,801.77,39.17,,641.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,716.45,1699.01,
LIDOCAINE (GLYDO) 2% TOPICAL JELLY,1690024,CDM,636,RC,,,both,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
MALIGNANT HYPERTHERMIA CART,1690046,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CEFPROZIL 125MG / 5ML ORAL SUSP,1690058,CDM,636,RC,,,both,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
GUAIFENESIN (ROBITUSSIN) 100MG / 5ML UD,1690063,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
FAMOTIDINE (PEPCID) 20MG / 2ML VIAL,1690070,CDM,636,RC,J3490,HCPCS,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
PROMETHAZINE/NS IVPB : 25MG/50ML,1690091,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KETAMINE 50MG / 5 ML SYRINGE,1690099,CDM,636,RC,,,both,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
BACTERIOSTATIC WATER FOR INJECTION,1690147,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
BUPRENORPHINE / NALOXONE 8MG/2MG TAB,1690169,CDM,636,RC,,,both,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
MAGNESIUM SULFATE 5 GRAMS / 10 ML VIAL,1690181,CDM,636,RC,,,both,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
LIDOCAINE 1% PRESERVATIVE FREE 50MG/5ML,1690187,CDM,636,RC,J2001,HCPCS,both,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,0.03,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.03,4.98,
DEXAMETHASONE 10MG/1ML PF,1690202,CDM,636,RC,,,both,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
FOSFOMYCIN (MONUROL) 3 GRAM ORAL SACHET,1690262,CDM,636,RC,,,both,,,277,138.5,,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.37,38.4,,85.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.95,35,,77.56,percent of total billed charges,35% of total billed charges for outpatient setting,216.06,78,,172.848,percent of total billed charges,78% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,193.9,70,,155.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,207.75,75,,166.2,percent of total billed charges,75% of total billed charges for outpatient setting,229.91,83,,183.928,percent of total billed charges,83% of total billed charges for outpatient setting,138.5,50,,110.8,percent of total billed charges,50% of total billed charges for outpatient setting,138.5,50,,110.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.5,39.17,,86.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,96.95,229.91,
POVIDONE-IODINE (BETADINE) 118 ML,1690278,CDM,250,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
PHENYLEPHRINE 500MCG/5ML AMP,1690313,CDM,636,RC,,,both,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
MUPIROCIN (BACTROBAN) OINT 1 GRAM TUBE,1690318,CDM,636,RC,,,both,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
"LIDO, EPI, TETRA ( L.E.T. ) TOP GEL",1690332,CDM,636,RC,,,both,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,46.48,
ETHYL CHLORIDE SPRAY MIST,1690333,CDM,636,RC,,,both,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.45,72.21,
MORPHINE ORAL 20MG/ML (GIP HOSPICE ONLY),1690437,CDM,636,RC,,,both,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
LORAZEPAM INTENSOL ORAL 2MG/ML,1690438,CDM,636,RC,,,both,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
ZINC OXIDE 20% OINTMENT 30 GRAM TUBE,1690515,CDM,636,RC,,,both,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
JUST LIKE TEMPLATE DETAILED DRUGS (AN),1699998,CDM,636,RC,,,both,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
JUST LIKE TEMPLATE SELF ADMIN DRUGS (AP),1699999,CDM,637,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
EXTENSION SET,1700014,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
ROSS FEED SET,1700015,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
VENTED HYPERAL SET,1700018,CDM,270,RC,,,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
INJECTION CAP,1700019,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
LIPID SET,1700020,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
VENTED NITRO SET,1700021,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
PRIMARY IV SET,1700022,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
SECONDARY MED SET,1700023,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
IV START PACK,1700025,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
THREE WAY STOPCOCK,1700026,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
TRANSFER SET,1700027,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
VIP SET & 72HR PUMP,1700028,CDM,270,RC,,,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.9,35,,54.32,percent of total billed charges,35% of total billed charges for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.99,39.17,,60.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.9,161.02,
Y EXTENSION SET,1700029,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
SOD CHLORIDE 0.45%,1700031,CDM,250,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
SOD CHLORIDE 0.45% I,1700035,CDM,250,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
SOD CHLORIDE 0.225%,1700100,CDM,250,RC,,,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,35,,15.96,percent of total billed charges,35% of total billed charges for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.33,39.17,,17.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.95,47.31,
500.00ML DEXTROSE 10% INJ,1706814,CDM,250,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
DEXTROSE 10% INJ. *,1706815,CDM,250,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
DEXTROSE 20% INJ. *,1706816,CDM,250,RC,,,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,53.12,
DEXTROSE 40% INJ. *,1706817,CDM,250,RC,,,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
DEXTROSE 50% INJ. *,1706819,CDM,250,RC,,,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.05,52.29,
D5W/NACL 0.2% INJ. *,1706820,CDM,250,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
D5.45NS /KCL 10MEQ I,1706821,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5.45NS /KCL 20MEQ I,1706822,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5.45NS /KCL 30MEQ I,1706823,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5.45NS /KCL40MEQ IN,1706824,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5W/NACL 0.45% INJ.,1706825,CDM,250,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
D5W 1000ML/KCL 20MEQ,1706826,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5LR 1000ML,1706828,CDM,250,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
D5W/NACL 0.9% INJ.,1706829,CDM,258,RC,J7042,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.67,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.59,26.56,
D5NS/KCL 20MEQ INJ.,1706831,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
D5NS/KCL 40MEQ INJ.,1706832,CDM,250,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
DEXTROSE 5% 100ML,1706833,CDM,250,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
DEXTROSE 5% 1000ML,1706834,CDM,258,RC,J7060,HCPCS,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,24.9,
1000CC D5W  ECF,1706835,CDM,250,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,1.66,
DEXTROSE 5% 250ML,1706836,CDM,258,RC,J7060,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,21.58,
DEXTROSE 5% 50ML,1706837,CDM,258,RC,J7060,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,31.54,
DEXTROSE 5% 500ML,1706838,CDM,258,RC,J7060,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.93,21.58,
I.V. FLUID 1000CC,1710001,CDM,250,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
3-WAY STOCK/EXT. SET,1710002,CDM,270,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
SOD CHLORIDE 1000CC,1710025,CDM,250,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
VIP NON-PVC ACCUSET,1710047,CDM,270,RC,,,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
LACTATED RINGERS INJ,1716041,CDM,636,RC,J7120,HCPCS,both,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,2.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.59,30.71,
SOD CHLORIDE 0.9% 10,1719690,CDM,250,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
SOD CHLORIDE 0.9% 10,1719691,CDM,258,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SOD CHLORIDE 0.9% 25,1719693,CDM,258,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
SOD CHLORIDE 0.9% 50,1719694,CDM,250,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
SOD CHLORIDE 0.9% 50,1719695,CDM,636,RC,J7040,HCPCS,both,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,1.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.42,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.35,20.75,
NS 1000ML/KCL 20MEQ,1719696,CDM,250,RC,,,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,35,,15.12,percent of total billed charges,35% of total billed charges for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.15,39.17,,16.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.9,44.82,
NS 1000ML/KCL 40MEQ,1719697,CDM,250,RC,,,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,35,,15.12,percent of total billed charges,35% of total billed charges for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.15,39.17,,16.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.9,44.82,
SODIUM CHLOR 0.9% IRRIGATION,1724246,CDM,250,RC,,,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.15,35,,13.72,percent of total billed charges,35% of total billed charges for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,39.17,,15.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.15,40.67,
SOD CHLORIDE .9% BAC,1724846,CDM,250,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
SOD CHLORIDE 0.9% IN,1724913,CDM,250,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
STERILE WATER INJECT,1725194,CDM,260,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,212,
AMINOSYN 8.5%,1730006,CDM,250,RC,,,outpatient,,,176,88,,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.6,35,,49.28,percent of total billed charges,35% of total billed charges for outpatient setting,137.28,78,,109.824,percent of total billed charges,78% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.08,83,,116.864,percent of total billed charges,83% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.93,39.17,,55.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,61.6,146.08,
AMINOSYN-RF 300CL,1730008,CDM,250,RC,,,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,60.55,143.59,
VOLUTROL SET,1730015,CDM,270,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
OR SET(PRIM/EXT STCK,1730017,CDM,270,RC,,,outpatient,,,259,129.5,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.65,35,,72.52,percent of total billed charges,35% of total billed charges for outpatient setting,202.02,78,,161.616,percent of total billed charges,78% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,214.97,83,,171.976,percent of total billed charges,83% of total billed charges for outpatient setting,129.5,50,,103.6,percent of total billed charges,50% of total billed charges for outpatient setting,129.5,50,,103.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.45,39.17,,81.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,90.65,214.97,
T CONNECTOR LUER SLI,1730018,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
PRIMARY 60 GTT SET,1730019,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
VOLUMETRIC SET     *,1730020,CDM,270,RC,,,outpatient,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,35,,14.28,percent of total billed charges,35% of total billed charges for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,39.17,,15.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.85,42.33,
DEXTROSE 10% INJ. *,1730022,CDM,250,RC,,,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,45.65,
REGULATOR IV EXTENSI,1730061,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
HEPLOCK EXTENSION SE,1730083,CDM,270,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
SOD CHLORIDE 0.9% 25,1730091,CDM,250,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
25GA BUTTERFLY ECF,1740012,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
TRANSFER SET,1740046,CDM,270,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
SECONDARY .22MIC.FIL,1740076,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
I V EXTENSION SET 20,1740080,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
SYRINGE PUMP SET,1740086,CDM,270,RC,,,outpatient,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,87.15,
PRIMARY ADD SET,1740094,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
SECONDARY SET,1740096,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
IV ACCESSARY KIT - ECF,1750003,CDM,260,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,212,
1000CC .45% SOD. CL. ECF,1770003,CDM,260,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,212,
1000CC 9% SOD. CL. ECF,1770006,CDM,260,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,212,
INJECTION CAP ECF,1770044,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
DIAL-A-FLOW SET ECF,1770046,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
INJECTION IM TRANQUALIZER,1780004,CDM,760,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
IV INFUSION IST HOUR,1780005,CDM,760,RC,96365,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,293.82,
INJECTION IV THERAPUTIC,1780008,CDM,760,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV TRANQUILIZER,1780009,CDM,760,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION ADM VACCINE/TAXOID,1780010,CDM,771,RC,90471,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.7,134.46,
100CC 9% SOD. CL. ECF,1790022,CDM,260,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,212,
ANES EACH ADD 1/4 HR,1810003,CDM,370,RC,,,outpatient,,,234,117,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.9,35,,65.52,percent of total billed charges,35% of total billed charges for outpatient setting,182.52,78,,146.016,percent of total billed charges,78% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.22,83,,155.376,percent of total billed charges,83% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,91.66,39.17,,73.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.9,194.22,
INJECTION EPIDURAL OF BLOOD/CL,1810021,CDM,370,RC,62273,HCPCS,outpatient,,,1379,689.5,,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,529.54,38.4,,423.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,529.54,38.4,,423.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,482.65,35,,386.12,percent of total billed charges,35% of total billed charges for outpatient setting,1075.62,78,,860.496,percent of total billed charges,78% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,1144.57,83,,915.656,percent of total billed charges,83% of total billed charges for outpatient setting,689.5,50,,551.6,percent of total billed charges,50% of total billed charges for outpatient setting,689.5,50,,551.6,percent of total billed charges,50% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,540.13,39.17,,432.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,482.65,1144.57,
BLOCK - AXILLARY/ANKLE,1815161,CDM,270,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
FIBEROPTIC INTUBATION,1815163,CDM,370,RC,,,outpatient,,,298,149,,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.43,38.4,,91.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.43,38.4,,91.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.3,35,,83.44,percent of total billed charges,35% of total billed charges for outpatient setting,232.44,78,,185.952,percent of total billed charges,78% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,208.6,70,,166.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,223.5,75,,178.8,percent of total billed charges,75% of total billed charges for outpatient setting,247.34,83,,197.872,percent of total billed charges,83% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,149,50,,119.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.72,39.17,,93.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,104.3,247.34,
BLOCK - ULNA NERVE,1815166,CDM,360,RC,,,outpatient,,,468,234,,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,179.71,38.4,,143.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.71,38.4,,143.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.8,35,,131.04,percent of total billed charges,35% of total billed charges for outpatient setting,365.04,78,,292.032,percent of total billed charges,78% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,83,,310.752,percent of total billed charges,83% of total billed charges for outpatient setting,234,50,,187.2,percent of total billed charges,50% of total billed charges for outpatient setting,234,50,,187.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.3,39.17,,146.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,163.8,388.44,
BLOCK - WRIST,1815169,CDM,360,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
PAIN MANAGEMENT - SPINAL,1815170,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
ANESTHESIA FIRST 30 MIN,1820001,CDM,370,RC,,,outpatient,,,468,234,,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,179.71,38.4,,143.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.71,38.4,,143.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.8,35,,131.04,percent of total billed charges,35% of total billed charges for outpatient setting,365.04,78,,292.032,percent of total billed charges,78% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,327.6,70,,262.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,388.44,83,,310.752,percent of total billed charges,83% of total billed charges for outpatient setting,234,50,,187.2,percent of total billed charges,50% of total billed charges for outpatient setting,234,50,,187.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.3,39.17,,146.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,163.8,388.44,
"EPIDURAL TRAY, CONT.",1850505,CDM,370,RC,,,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.95,35,,38.36,percent of total billed charges,35% of total billed charges for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.66,39.17,,42.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.95,113.71,
BLOCK POPLITEAL,1850523,CDM,360,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
CENTRAL LINE ARTERY,1850524,CDM,360,RC,36640,HCPCS,outpatient,,,4830,2415,,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,35,,1352.4,percent of total billed charges,35% of total billed charges for outpatient setting,3767.4,78,,3013.92,percent of total billed charges,78% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,4008.9,83,,3207.12,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1891.81,39.17,,1513.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,4008.9,
CENTRAL LINE VENOUS,1850525,CDM,360,RC,36640,HCPCS,outpatient,,,4830,2415,,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1854.72,38.4,,1483.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,35,,1352.4,percent of total billed charges,35% of total billed charges for outpatient setting,3767.4,78,,3013.92,percent of total billed charges,78% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,3381,70,,2704.8,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3622.5,75,,2898,percent of total billed charges,75% of total billed charges for outpatient setting,4008.9,83,,3207.12,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1891.81,39.17,,1513.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1690.5,4008.9,
GASTRIC INTUBATION LAVAGE FOR,1850526,CDM,360,RC,91105,HCPCS,outpatient,,,69,34.5,,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.5,38.4,,21.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.15,35,,19.32,percent of total billed charges,35% of total billed charges for outpatient setting,53.82,78,,43.056,percent of total billed charges,78% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,48.3,70,,38.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.75,75,,41.4,percent of total billed charges,75% of total billed charges for outpatient setting,57.27,83,,45.816,percent of total billed charges,83% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,34.5,50,,27.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.03,39.17,,21.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.15,57.27,
INJECTION IM THERAPEUTIC,1850527,CDM,360,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IV ANTIBIOTIC,1850528,CDM,360,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV THERAPEUTIC,1850529,CDM,360,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV TRANQUILIZER,1850530,CDM,360,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION SQ,1850531,CDM,360,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
LUMBAR PUNCTURE,1850532,CDM,360,RC,62270,HCPCS,outpatient,,,636,318,,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,244.22,38.4,,195.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,244.22,38.4,,195.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,477,75,,381.6,percent of total billed charges,75% of total billed charges for outpatient setting,477,75,,381.6,percent of total billed charges,75% of total billed charges for outpatient setting,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,477,75,,381.6,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,222.6,35,,178.08,percent of total billed charges,35% of total billed charges for outpatient setting,496.08,78,,396.864,percent of total billed charges,78% of total billed charges for outpatient setting,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,445.2,70,,356.16,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,477,75,,381.6,percent of total billed charges,75% of total billed charges for outpatient setting,527.88,83,,422.304,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.1,39.17,,199.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,222.6,1452,
PAIN MGT EPIDURAL,1850533,CDM,370,RC,1967,HCPCS,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
BLOCK CERVICAL OR THORACIC SIN,1850534,CDM,360,RC,64479,HCPCS,outpatient,,,1379,689.5,,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,529.54,38.4,,423.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,529.54,38.4,,423.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,482.65,35,,386.12,percent of total billed charges,35% of total billed charges for outpatient setting,1075.62,78,,860.496,percent of total billed charges,78% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,965.3,70,,772.24,percent of total billed charges,70% of total billed charges for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1034.25,75,,827.4,percent of total billed charges,75% of total billed charges for outpatient setting,1144.57,83,,915.656,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,540.13,39.17,,432.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,782.94,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,482.65,1452,
NERVE BLOCK INJ;TRIGEMINAL NER,1850535,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;FACIAL NERVE,1850536,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;OCCIPITAL NERV,1850537,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;VAGUS NERVE,1850538,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;PHRENIC NERVE,1850539,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;CERVICAL PLEXU,1850541,CDM,360,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
NERVE BLOCK INJ;BRACHIAL PLEXU,1850542,CDM,360,RC,,,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.45,138.61,
NERVE BLOCK INJ;AXILLARY NERVE,1850543,CDM,360,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
NERVE BLOCK INJ;SUPRASCAPULAR,1850544,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;INTERCOSTAL NE,1850545,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;INTERCOSTAL NE,1850546,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
"NERVE BLOCK INJ;ILIOINGUINAL,",1850547,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;PUDENDAL NERVE,1850548,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;PARACERVICAL (,1850549,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;SCIATIC NERVE,1850550,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;OTHER PERIPHER,1850551,CDM,360,RC,,,outpatient,,,283,141.5,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.67,38.4,,86.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.05,35,,79.24,percent of total billed charges,35% of total billed charges for outpatient setting,220.74,78,,176.592,percent of total billed charges,78% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,234.89,83,,187.912,percent of total billed charges,83% of total billed charges for outpatient setting,141.5,50,,113.2,percent of total billed charges,50% of total billed charges for outpatient setting,141.5,50,,113.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.84,39.17,,88.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,99.05,234.89,
NERVE BLOCK INJ;PARAVERTEBRAL,1850552,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;PARAVERTEBRAL,1850553,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;LUMBAR OR SACR,1850554,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;LUMBAR OR SACR,1850555,CDM,360,RC,,,outpatient,,,790,395,,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.36,38.4,,242.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.5,35,,221.2,percent of total billed charges,35% of total billed charges for outpatient setting,616.2,78,,492.96,percent of total billed charges,78% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,553,70,,442.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,592.5,75,,474,percent of total billed charges,75% of total billed charges for outpatient setting,655.7,83,,524.56,percent of total billed charges,83% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,395,50,,316,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.43,39.17,,247.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,276.5,655.7,
NERVE BLOCK INJ;RADIAL,1850556,CDM,360,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
BLOCK CERVICAL OR THORACIC EAC,1850557,CDM,360,RC,64480,HCPCS,outpatient,,,407,203.5,,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.29,38.4,,125.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.29,38.4,,125.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.45,35,,113.96,percent of total billed charges,35% of total billed charges for outpatient setting,317.46,78,,253.968,percent of total billed charges,78% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,337.81,83,,270.248,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.42,39.17,,127.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,142.45,659,
SPUTUM COLLECTION,1910021,CDM,410,RC,94664,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,212,
VENTILATOR CIRCUIT,1910030,CDM,270,RC,,,outpatient,,,32.92,16.46,,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.64,38.4,,10.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.64,38.4,,10.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,35,,9.216,percent of total billed charges,35% of total billed charges for outpatient setting,25.68,78,,20.544,percent of total billed charges,78% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,23.04,70,,18.432,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.69,75,,19.752,percent of total billed charges,75% of total billed charges for outpatient setting,27.32,83,,21.856,percent of total billed charges,83% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,16.46,50,,13.168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.89,39.17,,10.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.52,27.32,
OXYGEN PER HOUR,1910050,CDM,270,RC,,,outpatient,,,11.82,5.91,,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.54,38.4,,3.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.54,38.4,,3.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,8.87,75,,7.096,percent of total billed charges,75% of total billed charges for outpatient setting,8.87,75,,7.096,percent of total billed charges,75% of total billed charges for outpatient setting,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,8.87,75,,7.096,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.14,35,,3.312,percent of total billed charges,35% of total billed charges for outpatient setting,9.22,78,,7.376,percent of total billed charges,78% of total billed charges for outpatient setting,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,8.27,70,,6.616,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.87,75,,7.096,percent of total billed charges,75% of total billed charges for outpatient setting,9.81,83,,7.848,percent of total billed charges,83% of total billed charges for outpatient setting,5.91,50,,4.728,percent of total billed charges,50% of total billed charges for outpatient setting,5.91,50,,4.728,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.63,39.17,,3.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.14,9.81,
RESPIRATORY CODE TRAY,1910070,CDM,270,RC,,,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56.7,134.46,
VENTURI MASK,1910075,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
DISP CROUP TNT CANOP,1910110,CDM,270,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
JET NEBULIZER INITIAL,1910151,CDM,410,RC,94640,HCPCS,outpatient,,,168.52,84.26,,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,35,,47.184,percent of total billed charges,35% of total billed charges for outpatient setting,131.45,78,,105.16,percent of total billed charges,78% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,139.87,83,,111.896,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,39.17,,52.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,212,
PULSE OXIMETRY CONTINUOUS,1910170,CDM,460,RC,94762,HCPCS,outpatient,,,405,202.5,,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,155.52,38.4,,124.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.52,38.4,,124.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.75,35,,113.4,percent of total billed charges,35% of total billed charges for outpatient setting,315.9,78,,252.72,percent of total billed charges,78% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,336.15,83,,268.92,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.63,39.17,,126.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,424,
VENT SUBSEQUENT,1910180,CDM,410,RC,94003,HCPCS,outpatient,,,360,180,,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,538.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126,35,,100.8,percent of total billed charges,35% of total billed charges for outpatient setting,280.8,78,,224.64,percent of total billed charges,78% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,298.8,83,,239.04,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141,39.17,,112.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126,538.29,
ABG COMPLETE,1910200,CDM,300,RC,82805,HCPCS,outpatient,,,84.4,42.2,,59.08,70,,47.264,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,65.83,78,,52.664,percent of total billed charges,78% of total billed charges for outpatient setting,59.08,70,,47.264,percent of total billed charges,70% of total billed charges for outpatient setting,59.08,70,,47.264,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.3,75,,50.64,percent of total billed charges,75% of total billed charges for outpatient setting,70.05,83,,56.04,percent of total billed charges,83% of total billed charges for outpatient setting,42.2,50,,33.76,percent of total billed charges,50% of total billed charges for outpatient setting,42.2,50,,33.76,percent of total billed charges,50% of total billed charges for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,78.77,
POC ABG WITH LACTIC ACID,1910201,CDM,300,RC,82805,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,83,
VENTILATOR SET-UP,1910230,CDM,410,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212,212,
PULMONARY FUNCTION TEST SIMPLE,1910330,CDM,460,RC,94010,HCPCS,outpatient,,,510,255,,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,134.17,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,195.84,38.4,,156.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.5,35,,142.8,percent of total billed charges,35% of total billed charges for outpatient setting,397.8,78,,318.24,percent of total billed charges,78% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,357,70,,285.6,percent of total billed charges,70% of total billed charges for outpatient setting,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,382.5,75,,306,percent of total billed charges,75% of total billed charges for outpatient setting,423.3,83,,338.64,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.76,39.17,,159.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.17,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.17,424,
INCENTIVE SPIROMETRY,1910332,CDM,270,RC,,,outpatient,,,25.2,12.6,,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.68,38.4,,7.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.68,38.4,,7.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.82,35,,7.056,percent of total billed charges,35% of total billed charges for outpatient setting,19.66,78,,15.728,percent of total billed charges,78% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,20.92,83,,16.736,percent of total billed charges,83% of total billed charges for outpatient setting,12.6,50,,10.08,percent of total billed charges,50% of total billed charges for outpatient setting,12.6,50,,10.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.87,39.17,,7.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.82,20.92,
PULMONARY FUNCTION TEST COMPLETE,1910335,CDM,460,RC,94060,HCPCS,outpatient,,,946,473,,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,363.26,38.4,,290.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,363.26,38.4,,290.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,709.5,75,,567.6,percent of total billed charges,75% of total billed charges for outpatient setting,709.5,75,,567.6,percent of total billed charges,75% of total billed charges for outpatient setting,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,709.5,75,,567.6,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,331.1,35,,264.88,percent of total billed charges,35% of total billed charges for outpatient setting,737.88,78,,590.304,percent of total billed charges,78% of total billed charges for outpatient setting,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,662.2,70,,529.76,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,709.5,75,,567.6,percent of total billed charges,75% of total billed charges for outpatient setting,785.18,83,,628.144,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.53,39.17,,296.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,785.18,
CPT INITIAL,1910355,CDM,410,RC,94667,HCPCS,outpatient,,,338,169,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,129.79,38.4,,103.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.79,38.4,,103.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.3,35,,94.64,percent of total billed charges,35% of total billed charges for outpatient setting,263.64,78,,210.912,percent of total billed charges,78% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,280.54,83,,224.432,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.39,39.17,,105.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,280.54,
INTUBATION,1910371,CDM,410,RC,31500,HCPCS,outpatient,,,369,184.5,,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,141.7,38.4,,113.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,141.7,38.4,,113.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.15,35,,103.32,percent of total billed charges,35% of total billed charges for outpatient setting,287.82,78,,230.256,percent of total billed charges,78% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,258.3,70,,206.64,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.75,75,,221.4,percent of total billed charges,75% of total billed charges for outpatient setting,306.27,83,,245.016,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.53,39.17,,115.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.15,306.27,
PATIENT SUCTION,1911131,CDM,410,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212,212,
ARTERIAL PUNCTURE,1912107,CDM,410,RC,36600,HCPCS,outpatient,,,102.18,51.09,,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,39.24,38.4,,31.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.24,38.4,,31.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.76,35,,28.608,percent of total billed charges,35% of total billed charges for outpatient setting,79.7,78,,63.76,percent of total billed charges,78% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,71.53,70,,57.224,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.64,75,,61.312,percent of total billed charges,75% of total billed charges for outpatient setting,84.81,83,,67.848,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.02,39.17,,32.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.76,212,
MDI SPACER,1912109,CDM,270,RC,,,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
O2 SAT CHECK,1913333,CDM,460,RC,94760,HCPCS,outpatient,,,13.5,6.75,,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.18,38.4,,4.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.18,38.4,,4.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.73,35,,3.784,percent of total billed charges,35% of total billed charges for outpatient setting,10.53,78,,8.424,percent of total billed charges,78% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,9.45,70,,7.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.13,75,,8.104,percent of total billed charges,75% of total billed charges for outpatient setting,11.21,83,,8.968,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.28,39.17,,4.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.73,424,
VENT INITIAL,1913334,CDM,410,RC,94002,HCPCS,outpatient,,,360,180,,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,538.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126,35,,100.8,percent of total billed charges,35% of total billed charges for outpatient setting,280.8,78,,224.64,percent of total billed charges,78% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,298.8,83,,239.04,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141,39.17,,112.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,538.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126,538.29,
ACAPELLA/PEP SUBSEQUENT,1913335,CDM,410,RC,94668,HCPCS,outpatient,,,96.6,48.3,,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.09,38.4,,29.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.09,38.4,,29.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.81,35,,27.048,percent of total billed charges,35% of total billed charges for outpatient setting,75.35,78,,60.28,percent of total billed charges,78% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,67.62,70,,54.096,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.45,75,,57.96,percent of total billed charges,75% of total billed charges for outpatient setting,80.18,83,,64.144,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.83,39.17,,30.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.81,212,
ACAPELLA/PEP INITIAL,1913336,CDM,410,RC,94667,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.05,212,
JET NEB CONT. SUBSEQUENT,1913337,CDM,410,RC,94645,HCPCS,outpatient,,,102,51,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.7,35,,28.56,percent of total billed charges,35% of total billed charges for outpatient setting,79.56,78,,63.648,percent of total billed charges,78% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,84.66,83,,67.728,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.95,39.17,,31.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35.7,212,
JET NEB CONT INITIAL,1913338,CDM,410,RC,94644,HCPCS,outpatient,,,130.82,65.41,,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.23,38.4,,40.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.23,38.4,,40.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,98.12,75,,78.496,percent of total billed charges,75% of total billed charges for outpatient setting,98.12,75,,78.496,percent of total billed charges,75% of total billed charges for outpatient setting,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,98.12,75,,78.496,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.79,35,,36.632,percent of total billed charges,35% of total billed charges for outpatient setting,102.04,78,,81.632,percent of total billed charges,78% of total billed charges for outpatient setting,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,91.57,70,,73.256,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,98.12,75,,78.496,percent of total billed charges,75% of total billed charges for outpatient setting,108.58,83,,86.864,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.23,39.17,,40.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.79,212,
EDUCATION ON PATIENT,1913339,CDM,410,RC,98960,HCPCS,outpatient,,,78.49,39.25,,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.14,38.4,,24.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.14,38.4,,24.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,58.87,75,,47.096,percent of total billed charges,75% of total billed charges for outpatient setting,58.87,75,,47.096,percent of total billed charges,75% of total billed charges for outpatient setting,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,58.87,75,,47.096,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.47,35,,21.976,percent of total billed charges,35% of total billed charges for outpatient setting,61.22,78,,48.976,percent of total billed charges,78% of total billed charges for outpatient setting,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,54.94,70,,43.952,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.87,75,,47.096,percent of total billed charges,75% of total billed charges for outpatient setting,65.15,83,,52.12,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.74,39.17,,24.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.47,212,
NASOPHARYNGEAL TUBE,1920020,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
NORMAL SALINE,1922225,CDM,258,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
PROVENTIL,1922228,CDM,250,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
BI PAP,1930001,CDM,410,RC,94660,HCPCS,outpatient,,,285.27,142.64,,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.54,38.4,,87.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.54,38.4,,87.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,213.95,75,,171.16,percent of total billed charges,75% of total billed charges for outpatient setting,213.95,75,,171.16,percent of total billed charges,75% of total billed charges for outpatient setting,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,213.95,75,,171.16,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.84,35,,79.872,percent of total billed charges,35% of total billed charges for outpatient setting,222.51,78,,178.008,percent of total billed charges,78% of total billed charges for outpatient setting,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,199.69,70,,159.752,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.95,75,,171.16,percent of total billed charges,75% of total billed charges for outpatient setting,236.77,83,,189.416,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.73,39.17,,89.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.84,236.77,
HEATED MOISTURE EXCHANGE,1930011,CDM,270,RC,A4483,HCPCS,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.5,10.79,
MDI TREATMENT,1955565,CDM,410,RC,94640,HCPCS,outpatient,,,168.52,84.26,,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,35,,47.184,percent of total billed charges,35% of total billed charges for outpatient setting,131.45,78,,105.16,percent of total billed charges,78% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,139.87,83,,111.896,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,39.17,,52.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,212,
BREATH ALCOHOL TEST,1955573,CDM,300,RC,82075,HCPCS,outpatient,,,36.29,18.15,,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,30,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.94,38.4,,11.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.94,38.4,,11.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.7,35,,10.16,percent of total billed charges,35% of total billed charges for outpatient setting,28.31,78,,22.648,percent of total billed charges,78% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,25.4,70,,20.32,percent of total billed charges,70% of total billed charges for outpatient setting,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.22,75,,21.776,percent of total billed charges,75% of total billed charges for outpatient setting,30.12,83,,24.096,percent of total billed charges,83% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,18.15,50,,14.52,percent of total billed charges,50% of total billed charges for outpatient setting,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.22,39.17,,11.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.7,30.12,
CPT SUBSEQUENT,1960000,CDM,410,RC,94667,HCPCS,outpatient,,,338,169,,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,129.79,38.4,,103.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.79,38.4,,103.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.3,35,,94.64,percent of total billed charges,35% of total billed charges for outpatient setting,263.64,78,,210.912,percent of total billed charges,78% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,236.6,70,,189.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,253.5,75,,202.8,percent of total billed charges,75% of total billed charges for outpatient setting,280.54,83,,224.432,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.39,39.17,,105.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,280.54,
HOLTER MONITOR 48 HR,1960001,CDM,731,RC,93225,HCPCS,outpatient,,,893.2,446.6,,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,342.99,38.4,,274.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,342.99,38.4,,274.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,312.62,35,,250.096,percent of total billed charges,35% of total billed charges for outpatient setting,696.7,78,,557.36,percent of total billed charges,78% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,741.36,83,,593.088,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,349.85,39.17,,279.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,741.36,
TRACH CARE,1960002,CDM,410,RC,31502,HCPCS,outpatient,,,842,421,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,294.7,35,,235.76,percent of total billed charges,35% of total billed charges for outpatient setting,656.76,78,,525.408,percent of total billed charges,78% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,698.86,83,,559.088,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,329.8,39.17,,263.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,698.86,
JET NEB SUBSEQUENT 2ND MED,1960003,CDM,410,RC,94640,HCPCS,outpatient,,,168.52,84.26,,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,35,,47.184,percent of total billed charges,35% of total billed charges for outpatient setting,131.45,78,,105.16,percent of total billed charges,78% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,139.87,83,,111.896,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,39.17,,52.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,212,
JET NEB SUBSEQUENT,1960004,CDM,410,RC,94640,HCPCS,outpatient,,,168.52,84.26,,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,35,,47.184,percent of total billed charges,35% of total billed charges for outpatient setting,131.45,78,,105.16,percent of total billed charges,78% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,139.87,83,,111.896,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,39.17,,52.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,212,
MDI SUBSEQUENT,1960005,CDM,410,RC,94640,HCPCS,outpatient,,,168.52,84.26,,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.71,38.4,,51.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,35,,47.184,percent of total billed charges,35% of total billed charges for outpatient setting,131.45,78,,105.16,percent of total billed charges,78% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,117.96,70,,94.368,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.39,75,,101.112,percent of total billed charges,75% of total billed charges for outpatient setting,139.87,83,,111.896,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,39.17,,52.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.98,212,
MDI SUBSEQUENT MED 2,1960006,CDM,410,RC,94640,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,212,
JET NEB SUBSEQUENT 3RD MED,1960007,CDM,410,RC,94640,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,183.21,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,212,
VENOUS BLOOD GAS,1960008,CDM,410,RC,82805,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.69,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.47,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,78.77,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.98,212,
CANCEL RESPIRATORY ORDER,1990000,CDM,410,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212,212,
RESPIRATORY ORDER,1990001,CDM,410,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212,212,
EKG ORDER,1990002,CDM,410,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212,212,
PT PARAFFIN BATH,2010002,CDM,421,RC,97018,HCPCS,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,424,
PT PHONOPHORESIS,2010003,CDM,421,RC,97035,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
PT ELECTRICAL STIMULATION,2010005,CDM,421,RC,97014GP,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.25,35,,32.2,percent of total billed charges,35% of total billed charges for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.04,39.17,,36.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.25,424,
PT DIATHERMY,2010007,CDM,421,RC,97024,HCPCS,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.66,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6.66,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.95,424,
PT IONTOPHORESIS PER 15MIN,2010008,CDM,421,RC,97033,HCPCS,outpatient,,,174,87,,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.82,38.4,,53.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.82,38.4,,53.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.9,35,,48.72,percent of total billed charges,35% of total billed charges for outpatient setting,135.72,78,,108.576,percent of total billed charges,78% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,144.42,83,,115.536,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.16,39.17,,54.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,424,
PT ULTRAVIOLET,2010016,CDM,421,RC,97028,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,7.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.65,424,
PT ULTRASOUND PER 15 MIN,2010024,CDM,421,RC,97035,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
PT NEUROPROBE PER 15 MIN,2010025,CDM,421,RC,97032,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,424,
PT TENS TREATMENT,2010027,CDM,421,RC,97014,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.25,35,,32.2,percent of total billed charges,35% of total billed charges for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.04,39.17,,36.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.25,424,
PT WHIRLPOOL,2010035,CDM,421,RC,97022,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,424,
PT BIOFEEDBACK,2010040,CDM,421,RC,90901,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,424,
PT TENS INITIAL,2010048,CDM,421,RC,64550,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.05,424,
PT TILT TABLE,2010063,CDM,421,RC,97112,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,424,
PT MANUAL EXTREMITY OR TRUNK,2010065,CDM,421,RC,95831,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,424,
PT MANUAL HAND,2010066,CDM,421,RC,95832,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,424,
PT MANUAL TOTAL BODY WO HANDS,2010067,CDM,421,RC,95833,HCPCS,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,424,
PT MANUAL TOTAL BODY W HANDS,2010068,CDM,421,RC,95834,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28.35,424,
PT ROM EA EXTREMITY TRUCK W O HAN,2010069,CDM,421,RC,95851,HCPCS,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6.65,424,
PT ROM HAND,2010070,CDM,421,RC,95852,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,424,
PT FUNCTION EVALUATION PER 15 MIN,2010075,CDM,421,RC,97750,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,424,
PT HOME INSTRUCT PROGRAM,2010084,CDM,421,RC,16020,HCPCS,outpatient,,,136,68,,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.22,38.4,,41.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.6,35,,38.08,percent of total billed charges,35% of total billed charges for outpatient setting,106.08,78,,84.864,percent of total billed charges,78% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,95.2,70,,76.16,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102,75,,81.6,percent of total billed charges,75% of total billed charges for outpatient setting,112.88,83,,90.304,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.26,39.17,,42.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.6,424,
PT ELECTRODE MEDIUM,2010118,CDM,270,RC,99070,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
PT COMBO US ESTIM,2010124,CDM,421,RC,97032,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,424,
PT HOME TRACTION SET-UP,2010131,CDM,421,RC,97535,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,424,
PT SPRAY AND STRETCH,2010133,CDM,420,RC,97140,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,424,
PT TRACTION MECHANICAL,2010134,CDM,421,RC,97012,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,13.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,424,
PT CRUTCH TRAIN FIT,2010137,CDM,421,RC,97116,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,424,
PT GARMENT FIT & INSTRUCT PER 15M,2010143,CDM,421,RC,97535,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,424,
PT DEVELOPMENTAL TESTING EXTENDED,2010200,CDM,421,RC,96111,HCPCS,outpatient,,,319,159.5,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.65,35,,89.32,percent of total billed charges,35% of total billed charges for outpatient setting,248.82,78,,199.056,percent of total billed charges,78% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,264.77,83,,211.816,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.95,39.17,,99.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,111.65,424,
PT VASOPNEUMATIC PUMP,2010207,CDM,421,RC,97016,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,424,
PT MANUAL THERAPY PER 15 MIN,2010208,CDM,421,RC,97140GP,HCPCS,outpatient,,,203,101.5,,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.95,38.4,,62.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.05,35,,56.84,percent of total billed charges,35% of total billed charges for outpatient setting,158.34,78,,126.672,percent of total billed charges,78% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,142.1,70,,113.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.25,75,,121.8,percent of total billed charges,75% of total billed charges for outpatient setting,168.49,83,,134.792,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.51,39.17,,63.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,71.05,424,
PT GARMENT MEASURE PER 15 MIN,2010210,CDM,421,RC,97750,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,424,
PT TEST PHYS PERFORM PER 15 MIN,2010211,CDM,421,RC,97750,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,424,
PT WORK HARDENING INITIAL 2 HOURS,2010212,CDM,421,RC,97545,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT GAIT TRAINING PER 15 MIN,2010213,CDM,421,RC,97116,HCPCS,outpatient,,,59.08,29.54,,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.69,38.4,,18.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.69,38.4,,18.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.68,35,,16.544,percent of total billed charges,35% of total billed charges for outpatient setting,46.08,78,,36.864,percent of total billed charges,78% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,41.36,70,,33.088,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.31,75,,35.448,percent of total billed charges,75% of total billed charges for outpatient setting,49.04,83,,39.232,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.14,39.17,,18.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.68,424,
PT TRANSFER TRAIN PER 15 MIN,2010214,CDM,421,RC,97530,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.15,35,,47.32,percent of total billed charges,35% of total billed charges for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.2,39.17,,52.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,424,
PT DEV SENS INTEG PER 15 MIN,2010215,CDM,421,RC,97533,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,424,
PT NEURO MUSCULAR RE ED PER 15 MI,2010216,CDM,421,RC,97112,HCPCS,outpatient,,,315,157.5,,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,120.96,38.4,,96.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,120.96,38.4,,96.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.25,35,,88.2,percent of total billed charges,35% of total billed charges for outpatient setting,245.7,78,,196.56,percent of total billed charges,78% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,261.45,83,,209.16,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.38,39.17,,98.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,424,
PT THERAPEUTIC EXERCISE PER 15 MIN,2010217,CDM,421,RC,97110,HCPCS,outpatient,,,181.46,90.73,,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,69.68,38.4,,55.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.68,38.4,,55.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.51,35,,50.808,percent of total billed charges,35% of total billed charges for outpatient setting,141.54,78,,113.232,percent of total billed charges,78% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,150.61,83,,120.488,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.07,39.17,,56.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,424,
PT SELF CARE ADL PER 15 MIN,2010218,CDM,421,RC,97535,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,424,
PT SPLINT SHORT ARM STATIC,2010220,CDM,421,RC,29125,HCPCS,outpatient,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.65,35,,27.72,percent of total billed charges,35% of total billed charges for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.78,39.17,,31.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.65,424,
PT SPLINT SHORT ARM DYNAMIC,2010221,CDM,421,RC,29126,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,35,,34.16,percent of total billed charges,35% of total billed charges for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.79,39.17,,38.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,424,
PT SPLINT FINGER STATIC,2010222,CDM,421,RC,29130,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,424,
PT SPLINT FINGER DYNAMIC,2010223,CDM,421,RC,29131,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,424,
PT SPLINT LONG LEG,2010224,CDM,421,RC,29505,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,424,
PT SPLINT SHORT LEG,2010225,CDM,421,RC,29515,HCPCS,outpatient,,,127,63.5,,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.77,38.4,,39.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.77,38.4,,39.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.45,35,,35.56,percent of total billed charges,35% of total billed charges for outpatient setting,99.06,78,,79.248,percent of total billed charges,78% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,88.9,70,,71.12,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.25,75,,76.2,percent of total billed charges,75% of total billed charges for outpatient setting,105.41,83,,84.328,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.75,39.17,,39.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.45,424,
PT WHEELCHAIR MANAGEMENT PER 15 M,2010229,CDM,421,RC,97542,HCPCS,outpatient,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.95,35,,21.56,percent of total billed charges,35% of total billed charges for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.16,39.17,,24.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.95,424,
PT MULTI-LAYER COMPRESSION APP,2010235,CDM,421,RC,29581,HCPCS,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.55,424,
PT ORTHO FIT TRAIN PER 15 MIN,2010236,CDM,421,RC,97760,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,424,
PT ORTHO PROSTETIC CHECKOUT PER 1,2010237,CDM,421,RC,97762,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.6,424,
PT DEBRIDEMENT SELECTIVE,2010307,CDM,421,RC,97597,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,424,
PT DEBRIDEMENT SELECTIVE EXTENSIV,2010308,CDM,421,RC,97598,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,424,
PT GENERAL EVALUATION PARTIAL,2010309,CDM,424,RC,97001,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.45,424,
PT PROSTH FIT TRAIN PER 15 MIN,2010318,CDM,421,RC,97761,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,38.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.05,424,
PT BOOTS MULTPODUS,2010334,CDM,270,RC,99070,HCPCS,outpatient,,,209,104.5,,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.26,38.4,,64.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.26,38.4,,64.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.15,35,,58.52,percent of total billed charges,35% of total billed charges for outpatient setting,163.02,78,,130.416,percent of total billed charges,78% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,146.3,70,,117.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.75,75,,125.4,percent of total billed charges,75% of total billed charges for outpatient setting,173.47,83,,138.776,percent of total billed charges,83% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,104.5,50,,83.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.87,39.17,,65.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.15,173.47,
PT THERAPEUTIC ACTIVITIES PER 15,2010349,CDM,421,RC,97530,HCPCS,outpatient,,,142.64,71.32,,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,54.77,38.4,,43.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.77,38.4,,43.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.92,35,,39.936,percent of total billed charges,35% of total billed charges for outpatient setting,111.26,78,,89.008,percent of total billed charges,78% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,118.39,83,,94.712,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.87,39.17,,44.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,424,
PT DEBRIDE NON SELECTIVE,2010350,CDM,421,RC,97602,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.5,424,
PT DOPPLER US,2010352,CDM,421,RC,97039,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,424,
PT ICE MASSAGE,2010375,CDM,421,RC,97039,HCPCS,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,35,,26.04,percent of total billed charges,35% of total billed charges for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.42,39.17,,29.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.55,424,
PT COGNITIVE SKILLS PER 15 MIN,2010376,CDM,421,RC,97532,HCPCS,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.7,424,
PT WOUND VAC RENTAL PER DAY,2010377,CDM,421,RC,A6550,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.6,424,
PT ELECTRICAL STIMULATION CHRONIC,2010378,CDM,421,RC,G0281,HCPCS,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,424,
PT UNNA BOOT PROFORE APPLICATION,2010379,CDM,421,RC,29580,HCPCS,outpatient,,,175,87.5,,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,38.4,,53.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.25,35,,49,percent of total billed charges,35% of total billed charges for outpatient setting,136.5,78,,109.2,percent of total billed charges,78% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,122.5,70,,98,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.25,75,,105,percent of total billed charges,75% of total billed charges for outpatient setting,145.25,83,,116.2,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.54,39.17,,54.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.25,424,
PT WOUND VAC AREA <OR=50 SQ CM,2010380,CDM,421,RC,97605,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,424,
PT WOUND VAC AREA > 50 SQ CM,2010381,CDM,421,RC,97606,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,424,
PT GROUP THERAPY,2010382,CDM,421,RC,97150,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.4,424,
PT BILATERAL UNNA BOOT APPLICATIO,2010383,CDM,421,RC,2958050,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,424,
PT APLIGRAF APPLICATION F SQ CM L,2010693,CDM,360,RC,15271,HCPCS,outpatient,,,4234,2117,,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,35,,1185.52,percent of total billed charges,35% of total billed charges for outpatient setting,3302.52,78,,2642.016,percent of total billed charges,78% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3514.22,83,,2811.376,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.38,39.17,,1326.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,3514.22,
PT APLIGRAF APPLICATION EA ADD 25,2010694,CDM,360,RC,15272,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,659,
PT APLIGRAF PER SQ CENTIMETER,2010695,CDM,636,RC,Q4101,HCPCS,both,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,81.34,
PT APLIGRAF APPLICATION F 100SQ C,2010696,CDM,360,RC,15273,HCPCS,outpatient,,,6978,3489,,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,3081.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2679.55,38.4,,2143.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2679.55,38.4,,2143.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,5233.5,75,,4186.8,percent of total billed charges,75% of total billed charges for outpatient setting,5233.5,75,,4186.8,percent of total billed charges,75% of total billed charges for outpatient setting,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,5233.5,75,,4186.8,percent of total billed charges,75% of total billed charges for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2442.3,35,,1953.84,percent of total billed charges,35% of total billed charges for outpatient setting,5442.84,78,,4354.272,percent of total billed charges,78% of total billed charges for outpatient setting,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,4884.6,70,,3907.68,percent of total billed charges,70% of total billed charges for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5233.5,75,,4186.8,percent of total billed charges,75% of total billed charges for outpatient setting,5791.74,83,,4633.392,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2733.14,39.17,,2186.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2442.3,5791.74,
PT APLIGRAF APPLICATION E ADD 100,2010697,CDM,360,RC,15274,HCPCS,outpatient,,,294,147,,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.9,35,,82.32,percent of total billed charges,35% of total billed charges for outpatient setting,229.32,78,,183.456,percent of total billed charges,78% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,244.02,83,,195.216,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.16,39.17,,92.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.9,659,
PT APLIGRAF APPLICATION FIRST 25,2010698,CDM,360,RC,15275,HCPCS,outpatient,,,4234,2117,,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,35,,1185.52,percent of total billed charges,35% of total billed charges for outpatient setting,3302.52,78,,2642.016,percent of total billed charges,78% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3514.22,83,,2811.376,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.38,39.17,,1326.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,3514.22,
PT APLIGRAF APPLICATION E ADD 25,2010699,CDM,360,RC,15276,HCPCS,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,659,
PT APLIGRAF APPLICATION F 100 SQ,2010700,CDM,360,RC,15277,HCPCS,outpatient,,,4234,2117,,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1625.86,38.4,,1300.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,35,,1185.52,percent of total billed charges,35% of total billed charges for outpatient setting,3302.52,78,,2642.016,percent of total billed charges,78% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,2963.8,70,,2371.04,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3175.5,75,,2540.4,percent of total billed charges,75% of total billed charges for outpatient setting,3514.22,83,,2811.376,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.38,39.17,,1326.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1481.9,3514.22,
PT APLIGRAF APPLICATION E ADD 100,2010701,CDM,360,RC,15278,HCPCS,outpatient,,,294,147,,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.9,38.4,,90.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.9,35,,82.32,percent of total billed charges,35% of total billed charges for outpatient setting,229.32,78,,183.456,percent of total billed charges,78% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,70,,164.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.5,75,,176.4,percent of total billed charges,75% of total billed charges for outpatient setting,244.02,83,,195.216,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.16,39.17,,92.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.9,659,
PT MOBILITY CURRENT STATUS,2010702,CDM,421,RC,G8978,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT MOBILITY GOAL STATUS,2010703,CDM,421,RC,G8979,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT MOBILITY DC STATUS,2010704,CDM,421,RC,G8980,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT BODY POSITION CURRENT STATUS,2010705,CDM,421,RC,G8981,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT BODY POSITION GOAL STATUS,2010706,CDM,421,RC,G8982,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT BODY POSITION DC STATUS,2010707,CDM,421,RC,G8983,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT CARRY CURRENT STATUS,2010708,CDM,421,RC,G8984,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT CARRY GOAL STATUS,2010709,CDM,421,RC,G8985,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT CARRY DC STATUS,2010710,CDM,421,RC,G8986,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT SELF CARE CURRENT STATUS,2010711,CDM,421,RC,G8987,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT SELF CARE GOAL STATUS,2010712,CDM,421,RC,G8988,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT SELF CARE DC STATUS,2010713,CDM,421,RC,G8989,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT OTHER PT OT CURRENT STATUS,2010714,CDM,421,RC,G8990,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT OTHER PT OT GOAL STATUS,2010715,CDM,421,RC,G8991,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT OTHER PT OT DC STATUS,2010716,CDM,421,RC,G8992,HCPCS,outpatient,,,0.01,0.01,,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,78,,0.008,percent of total billed charges,78% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,0.01,70,,0.008,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,75,,0.008,percent of total billed charges,75% of total billed charges for outpatient setting,0.01,83,,0.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.01,424,
PT SUB PT OT CURRENT STATUS,2010717,CDM,421,RC,G8993,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT SUB PT OT GOAL STATUS,2010718,CDM,421,RC,G8994,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT SUB PT OT DC STATUS,2010719,CDM,421,RC,G8995,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT PHYSICAL DEMAND ANALYSIS,2010720,CDM,421,RC,,,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.8,424,
PT EVAL LOW COMPLEX 20 MIN,2010721,CDM,421,RC,97161,HCPCS,outpatient,,,412.72,206.36,,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,93.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.45,35,,115.56,percent of total billed charges,35% of total billed charges for outpatient setting,321.92,78,,257.536,percent of total billed charges,78% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,342.56,83,,274.048,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161.65,39.17,,129.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,424,
PT EVAL MOD COMPLEX 30 MIN,2010722,CDM,421,RC,97162GP,HCPCS,outpatient,,,412.72,206.36,,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.45,35,,115.56,percent of total billed charges,35% of total billed charges for outpatient setting,321.92,78,,257.536,percent of total billed charges,78% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,342.56,83,,274.048,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.65,39.17,,129.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,144.45,424,
PT EVAL HIGH COMPLEX 45 MIN,2010723,CDM,421,RC,97163,HCPCS,outpatient,,,489,244.5,,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,93.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.78,38.4,,150.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.78,38.4,,150.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.15,35,,136.92,percent of total billed charges,35% of total billed charges for outpatient setting,381.42,78,,305.136,percent of total billed charges,78% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,405.87,83,,324.696,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.54,39.17,,153.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,93.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.24,424,
PT RE-EVAL EST PLAN CARE,2010724,CDM,421,RC,97164,HCPCS,outpatient,,,286,143,,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.82,38.4,,87.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.1,35,,80.08,percent of total billed charges,35% of total billed charges for outpatient setting,223.08,78,,178.464,percent of total billed charges,78% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,200.2,70,,160.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,214.5,75,,171.6,percent of total billed charges,75% of total billed charges for outpatient setting,237.38,83,,189.904,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.02,39.17,,89.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,64.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.34,424,
PT PHYSICAL OPTUM TX SCREENING,2010725,CDM,421,RC,99368,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.9,424,
PT JOB FUNCTION EVALUATION,2010726,CDM,421,RC,,,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,424,
PT ORDER,2050000,CDM,420,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
CANCEL REHAB ORDER,2050001,CDM,420,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
PT-BODY POS CURRENT G8981-CH,2090000,CDM,420,RC,G8981CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CI,2090001,CDM,420,RC,G8981CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CJ,2090002,CDM,420,RC,G8981CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CK,2090003,CDM,420,RC,G8981CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CL,2090004,CDM,420,RC,G8981CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CM,2090005,CDM,420,RC,G8981CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS CURRENT G8981-CN,2090006,CDM,420,RC,G8981CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CH,2090007,CDM,420,RC,G8986CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CI,2090008,CDM,420,RC,G8986CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CJ,2090009,CDM,420,RC,G8986CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CK,2090010,CDM,420,RC,G8986CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CL,2090011,CDM,420,RC,G8986CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CM,2090012,CDM,420,RC,G8986CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY DC G8986-CN,2090013,CDM,420,RC,G8986CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CH,2090014,CDM,420,RC,G8985CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CI,2090015,CDM,420,RC,G8985CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CJ,2090016,CDM,420,RC,G8985CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CK,2090017,CDM,420,RC,G8985CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CL,2090018,CDM,420,RC,G8985CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CM,2090019,CDM,420,RC,G8985CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY GOAL G8985-CN,2090020,CDM,420,RC,G8985CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CH,2090021,CDM,420,RC,G8989CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CI,2090022,CDM,420,RC,G8989CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CJ,2090023,CDM,420,RC,G8989CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CK,2090024,CDM,420,RC,G8989CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CL,2090025,CDM,420,RC,G8989CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CM,2090026,CDM,420,RC,G8989CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE DC G8989-CN,2090027,CDM,420,RC,G8989CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CH,2090028,CDM,420,RC,G8988CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CI,2090029,CDM,420,RC,G8988CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CJ,2090030,CDM,420,RC,G8988CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CK,2090031,CDM,420,RC,G8988CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CL,2090032,CDM,420,RC,G8988CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CM,2090033,CDM,420,RC,G8988CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE GOAL G8988-CN,2090034,CDM,420,RC,G8988CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CH,2090035,CDM,420,RC,G8994CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CI,2090036,CDM,420,RC,G8994CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CJ,2090037,CDM,420,RC,G8994CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CK,2090038,CDM,420,RC,G8994CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CL,2090039,CDM,420,RC,G8994CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CM,2090040,CDM,420,RC,G8994CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT GOAL G8994-CN,2090041,CDM,420,RC,G8994CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CH,2090042,CDM,420,RC,G8983CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CI,2090043,CDM,420,RC,G8983CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CJ,2090044,CDM,420,RC,G8983CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CK,2090045,CDM,420,RC,G8983CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CL,2090046,CDM,420,RC,G8983CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CM,2090047,CDM,420,RC,G8983CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS DC G8983-CN,2090048,CDM,420,RC,G8983CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CH,2090049,CDM,420,RC,G8982CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CI,2090050,CDM,420,RC,G8982CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CJ,2090051,CDM,420,RC,G8982CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CK,2090052,CDM,420,RC,G8982CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CL,2090053,CDM,420,RC,G8982CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CM,2090054,CDM,420,RC,G8982CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-BODY POS GOAL G8982-CN,2090055,CDM,420,RC,G8982CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CH,2090056,CDM,420,RC,G8984CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CI,2090057,CDM,420,RC,G8984CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CJ,2090058,CDM,420,RC,G8984CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CK,2090059,CDM,420,RC,G8984CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CL,2090060,CDM,420,RC,G8984CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CM,2090061,CDM,420,RC,G8984CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-CARRY CURRENT G8984 -CN,2090062,CDM,420,RC,G8984CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CH,2090063,CDM,420,RC,G8978CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CI,2090064,CDM,420,RC,G8978CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CJ,2090065,CDM,420,RC,G8978CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CK,2090066,CDM,420,RC,G8978CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CL,2090067,CDM,420,RC,G8978CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CM,2090068,CDM,420,RC,G8978CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY CURRENT G8978- CN,2090069,CDM,420,RC,G8978CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CH,2090070,CDM,420,RC,G8980CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CI,2090071,CDM,420,RC,G8980CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CJ,2090072,CDM,420,RC,G8980CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CK,2090073,CDM,420,RC,G8980CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CL,2090074,CDM,420,RC,G8980CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CM,2090075,CDM,420,RC,G8980CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY DC G8980-CN,2090076,CDM,420,RC,G8980CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CH,2090077,CDM,420,RC,G8979CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CI,2090078,CDM,420,RC,G8979CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CJ,2090079,CDM,420,RC,G8979CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CK,2090080,CDM,420,RC,G8979CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CL,2090081,CDM,420,RC,G8979CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CM,2090082,CDM,420,RC,G8979CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-MOBILITY GOAL G8979-CN,2090083,CDM,420,RC,G8979CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CH,2090084,CDM,420,RC,G8990CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CI,2090085,CDM,420,RC,G8990CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CJ,2090086,CDM,420,RC,G8990CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CK,2090087,CDM,420,RC,G8990CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CL,2090088,CDM,420,RC,G8990CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CM,2090089,CDM,420,RC,G8990CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT CURRENT G8990-CN,2090090,CDM,420,RC,G8990CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CH,2090091,CDM,420,RC,G8992CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CI,2090092,CDM,420,RC,G8992CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CJ,2090093,CDM,420,RC,G8992CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CK,2090094,CDM,420,RC,G8992CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CL,2090095,CDM,420,RC,G8992CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CM,2090096,CDM,420,RC,G8992CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT DC G8992-CN,2090097,CDM,420,RC,G8992CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CH,2090098,CDM,420,RC,G8991CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CI,2090099,CDM,420,RC,G8991CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CJ,2090100,CDM,420,RC,G8991CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CK,2090101,CDM,420,RC,G8991CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CL,2090102,CDM,420,RC,G8991CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CM,2090103,CDM,420,RC,G8991CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-OTHER PT/OT GOAL G8991-CN,2090104,CDM,420,RC,G8991CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CH,2090105,CDM,420,RC,G8987CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CI,2090106,CDM,420,RC,G8987CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CJ,2090107,CDM,420,RC,G8987CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CK,2090108,CDM,420,RC,G8987CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CL,2090109,CDM,420,RC,G8987CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CM,2090110,CDM,420,RC,G8987CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SELF-CARE CURRENT G8987-CN,2090111,CDM,420,RC,G8987CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CH,2090112,CDM,420,RC,G8993CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CI,2090113,CDM,420,RC,G8993CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CJ,2090114,CDM,420,RC,G8993CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CK,2090115,CDM,420,RC,G8993CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CL,2090116,CDM,420,RC,G8993CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CM,2090117,CDM,420,RC,G8993CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT CURRENT G8993-CN,2090118,CDM,420,RC,G8993CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CH,2090119,CDM,420,RC,G8995CHGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CI,2090120,CDM,420,RC,G8995CIGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CJ,2090121,CDM,420,RC,G8995CJGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CK,2090122,CDM,420,RC,G8995CKGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CL,2090123,CDM,420,RC,G8995CLGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CM,2090124,CDM,420,RC,G8995CMGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
PT-SUB PT/OT DC G8995-CN,2090125,CDM,420,RC,G8995CNGP,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
SLEEP STUDY PSG,2230014,CDM,740,RC,95810,HCPCS,outpatient,,,2098.18,1049.09,,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,805.7,38.4,,644.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,805.7,38.4,,644.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,1573.64,75,,1258.912,percent of total billed charges,75% of total billed charges for outpatient setting,1573.64,75,,1258.912,percent of total billed charges,75% of total billed charges for outpatient setting,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,1573.64,75,,1258.912,percent of total billed charges,75% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,734.36,35,,587.488,percent of total billed charges,35% of total billed charges for outpatient setting,1636.58,78,,1309.264,percent of total billed charges,78% of total billed charges for outpatient setting,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,1468.73,70,,1174.984,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1573.64,75,,1258.912,percent of total billed charges,75% of total billed charges for outpatient setting,1741.49,83,,1393.192,percent of total billed charges,83% of total billed charges for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,821.81,39.17,,657.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,734.36,1741.49,
SLEEP STUDY WITH TITRATION,2230017,CDM,740,RC,95811,HCPCS,outpatient,,,2486,1243,,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,954.62,38.4,,763.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,954.62,38.4,,763.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,870.1,35,,696.08,percent of total billed charges,35% of total billed charges for outpatient setting,1939.08,78,,1551.264,percent of total billed charges,78% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,2063.38,83,,1650.704,percent of total billed charges,83% of total billed charges for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,973.71,39.17,,778.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,870.1,2063.38,
SLEEP STUDY MSLT/MWT,2230018,CDM,740,RC,95805,HCPCS,outpatient,,,1776,888,,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,460.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,681.98,38.4,,545.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,681.98,38.4,,545.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,621.6,35,,497.28,percent of total billed charges,35% of total billed charges for outpatient setting,1385.28,78,,1108.224,percent of total billed charges,78% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,1243.2,70,,994.56,percent of total billed charges,70% of total billed charges for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1332,75,,1065.6,percent of total billed charges,75% of total billed charges for outpatient setting,1474.08,83,,1179.264,percent of total billed charges,83% of total billed charges for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,695.62,39.17,,556.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,1474.08,
OVERNIGHT PULSE OXIMETRY,2230019,CDM,460,RC,94762,HCPCS,outpatient,,,270,135,,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,103.68,38.4,,82.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,103.68,38.4,,82.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,202.5,75,,162,percent of total billed charges,75% of total billed charges for outpatient setting,202.5,75,,162,percent of total billed charges,75% of total billed charges for outpatient setting,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,202.5,75,,162,percent of total billed charges,75% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,35,,75.6,percent of total billed charges,35% of total billed charges for outpatient setting,210.6,78,,168.48,percent of total billed charges,78% of total billed charges for outpatient setting,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,189,70,,151.2,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.5,75,,162,percent of total billed charges,75% of total billed charges for outpatient setting,224.1,83,,179.28,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.75,39.17,,84.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,424,
HOME SLEEP TEST TYPE III,2230020,CDM,740,RC,95806,HCPCS,outpatient,,,1474.2,737.1,,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,566.09,38.4,,452.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,566.09,38.4,,452.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,1105.65,75,,884.52,percent of total billed charges,75% of total billed charges for outpatient setting,1105.65,75,,884.52,percent of total billed charges,75% of total billed charges for outpatient setting,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,1105.65,75,,884.52,percent of total billed charges,75% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,515.97,35,,412.776,percent of total billed charges,35% of total billed charges for outpatient setting,1149.88,78,,919.904,percent of total billed charges,78% of total billed charges for outpatient setting,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,1031.94,70,,825.552,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1105.65,75,,884.52,percent of total billed charges,75% of total billed charges for outpatient setting,1223.59,83,,978.872,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,577.41,39.17,,461.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,1223.59,
PAP DESENSITIZATION,2230021,CDM,740,RC,95807,HCPCS,outpatient,,,1812,906,,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,460.39,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,695.81,38.4,,556.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,695.81,38.4,,556.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,1359,75,,1087.2,percent of total billed charges,75% of total billed charges for outpatient setting,1359,75,,1087.2,percent of total billed charges,75% of total billed charges for outpatient setting,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,1359,75,,1087.2,percent of total billed charges,75% of total billed charges for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,634.2,35,,507.36,percent of total billed charges,35% of total billed charges for outpatient setting,1413.36,78,,1130.688,percent of total billed charges,78% of total billed charges for outpatient setting,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,1268.4,70,,1014.72,percent of total billed charges,70% of total billed charges for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1359,75,,1087.2,percent of total billed charges,75% of total billed charges for outpatient setting,1503.96,83,,1203.168,percent of total billed charges,83% of total billed charges for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,709.73,39.17,,567.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,460.39,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,460.39,1503.96,
SLEEP STUDY SPLIT NIGHT,2230022,CDM,740,RC,95811,HCPCS,outpatient,,,2486,1243,,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,954.62,38.4,,763.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,954.62,38.4,,763.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,870.1,35,,696.08,percent of total billed charges,35% of total billed charges for outpatient setting,1939.08,78,,1551.264,percent of total billed charges,78% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,1740.2,70,,1392.16,percent of total billed charges,70% of total billed charges for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1864.5,75,,1491.6,percent of total billed charges,75% of total billed charges for outpatient setting,2063.38,83,,1650.704,percent of total billed charges,83% of total billed charges for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,1273,100,,,case rate,100% UHC case rate for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,973.71,39.17,,778.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,898.09,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,870.1,2063.38,
WRAP - ACE 6  DOUBLE LENGTH,2600001,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
BANDAGE - 6  ELASTIC SWIFTWRAP,2600002,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BOTTLE - BABY,2600003,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
BITE STICK,2600004,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
SPRING-WIRE GUIDE - .025 MARKE,2600005,CDM,278,RC,C1769,HCPCS,both,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47,70,,37.6,percent of total billed charges,70% of total billed charges for outpatient setting,47,70,,37.6,percent of total billed charges,70% of total billed charges for outpatient setting,47,70,,37.6,percent of total billed charges,70% of total billed charges for outpatient setting,47,75,,37.6,percent of total billed charges,75% of total billed charges for outpatient setting,47,75,,37.6,percent of total billed charges,75% of total billed charges for outpatient setting,47,70,,37.6,percent of total billed charges,70% of total billed charges for outpatient setting,47,75,,37.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,47,
POUCH - 1.5  DRAINABLE OSTOMY,2600006,CDM,274,RC,A5063,HCPCS,both,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,70,,24,percent of total billed charges,70% of total billed charges for outpatient setting,30,70,,24,percent of total billed charges,70% of total billed charges for outpatient setting,30,70,,24,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,70,,24,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,30,
POUCH - 2.25  DRAINABLE OSTOMY,2600007,CDM,274,RC,A5063,HCPCS,both,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,42,
WAFER - 2.25  OSTOMY W/FLANGE,2600008,CDM,274,RC,A4414,HCPCS,both,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25,50,
WAFER - 1.5  OSTOMY,2600009,CDM,274,RC,A4414,HCPCS,both,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,70,,40.8,percent of total billed charges,70% of total billed charges for outpatient setting,51,70,,40.8,percent of total billed charges,70% of total billed charges for outpatient setting,51,70,,40.8,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,70,,40.8,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,51,
VALVE - ANTI-REFLUX SALEM SUMP,2600010,CDM,270,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
POUCH - ONE PIECE DRAINABLE,2600011,CDM,274,RC,A5061,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.5,61,
HOLDER - LIMB FOAM QUICK RELEASE 1 STRAP,2600012,CDM,270,RC,E0710,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
RESTRAINT - MD VEST,2600014,CDM,270,RC,E0710,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,45.65,
SCALPEL - #10,2600015,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CATH - 12FR FOLEY,2600016,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
KIT - 14FR SUCTION CATH,2600017,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
TRAY - TRACHEOSTOMY CLEAN/CARE,2600018,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
PLUG - CATH,2600019,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
FILTER - URINE,2600020,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
SYSTEM - 14FR CLOSED SUCTION,2600021,CDM,270,RC,,,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
SLING - PED ARM,2600022,CDM,274,RC,A4565,HCPCS,both,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16,70,,12.8,percent of total billed charges,70% of total billed charges for outpatient setting,16,70,,12.8,percent of total billed charges,70% of total billed charges for outpatient setting,16,70,,12.8,percent of total billed charges,70% of total billed charges for outpatient setting,16,75,,12.8,percent of total billed charges,75% of total billed charges for outpatient setting,16,75,,12.8,percent of total billed charges,75% of total billed charges for outpatient setting,16,70,,12.8,percent of total billed charges,70% of total billed charges for outpatient setting,16,75,,12.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,16,
ARMBOARD - INFANT 1X4,2600023,CDM,270,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
IMMOB - SM KNEE SUPER SPLINT,2600024,CDM,274,RC,L1830,HCPCS,both,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,70,,105.6,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,66,50,,52.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.2,132,
SPLINT - SM LT COCKUP,2600025,CDM,274,RC,L3908,HCPCS,both,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52,70,,41.6,percent of total billed charges,70% of total billed charges for outpatient setting,52,70,,41.6,percent of total billed charges,70% of total billed charges for outpatient setting,52,70,,41.6,percent of total billed charges,70% of total billed charges for outpatient setting,52,75,,41.6,percent of total billed charges,75% of total billed charges for outpatient setting,52,75,,41.6,percent of total billed charges,75% of total billed charges for outpatient setting,52,70,,41.6,percent of total billed charges,70% of total billed charges for outpatient setting,52,75,,41.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.2,52,
SPLINT - SM LT WRIST,2600027,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - LG RT PD FOREARM,2600028,CDM,270,RC,L3807,HCPCS,outpatient,,,317,158.5,,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.73,38.4,,97.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.73,38.4,,97.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,237.75,75,,190.2,percent of total billed charges,75% of total billed charges for outpatient setting,237.75,75,,190.2,percent of total billed charges,75% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,237.75,75,,190.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.95,35,,88.76,percent of total billed charges,35% of total billed charges for outpatient setting,247.26,78,,197.808,percent of total billed charges,78% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,237.75,75,,190.2,percent of total billed charges,75% of total billed charges for outpatient setting,263.11,83,,210.488,percent of total billed charges,83% of total billed charges for outpatient setting,158.5,50,,126.8,percent of total billed charges,50% of total billed charges for outpatient setting,158.5,50,,126.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.16,39.17,,99.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,110.95,263.11,
SPLINT - SM RT COCKUP,2600029,CDM,274,RC,L3908,HCPCS,both,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,86,
SPLINT - MD LT COCKUP,2600030,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - MD RT COCKUP,2600031,CDM,274,RC,L3908,HCPCS,both,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,86,
SPLINT - LG LT COCKUP,2600032,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - LG RT COCKUP,2600033,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - SM RT WRIST,2600034,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - MD LT WRIST,2600035,CDM,274,RC,L3908,HCPCS,both,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,86,
SPLINT - MD RT WRIST,2600036,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - LG RT WRIST,2600037,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - XLG LT WRIST,2600038,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
SPLINT - XLG RT WRIST,2600039,CDM,274,RC,L3908,HCPCS,both,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,86,70,,68.8,percent of total billed charges,70% of total billed charges for outpatient setting,86,75,,68.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,86,
SLING - SM ARM,2600040,CDM,274,RC,A4565,HCPCS,both,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,23,
SLING - MD ARM,2600041,CDM,274,RC,A4565,HCPCS,both,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17,70,,13.6,percent of total billed charges,70% of total billed charges for outpatient setting,17,70,,13.6,percent of total billed charges,70% of total billed charges for outpatient setting,17,70,,13.6,percent of total billed charges,70% of total billed charges for outpatient setting,17,75,,13.6,percent of total billed charges,75% of total billed charges for outpatient setting,17,75,,13.6,percent of total billed charges,75% of total billed charges for outpatient setting,17,70,,13.6,percent of total billed charges,70% of total billed charges for outpatient setting,17,75,,13.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,17,
SLING - LG ARM,2600042,CDM,274,RC,A4565,HCPCS,both,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,23,
COLLAR - STIFNECK REG,2600043,CDM,270,RC,L0150,HCPCS,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,35,,37.8,percent of total billed charges,35% of total billed charges for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.88,39.17,,42.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.25,112.05,
RESTRAINT - LG VEST WRAP AROUND,2600044,CDM,270,RC,E0710,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,45.65,
IMMOB - MD KNEE SUPER SPLINT,2600045,CDM,274,RC,L1830,HCPCS,both,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,129,
IMMOB - LG KNEE SUPER SPLINT,2600046,CDM,274,RC,29515,HCPCS,both,,,422,211,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,422,70,,337.6,percent of total billed charges,70% of total billed charges for outpatient setting,422,70,,337.6,percent of total billed charges,70% of total billed charges for outpatient setting,422,70,,337.6,percent of total billed charges,70% of total billed charges for outpatient setting,422,75,,337.6,percent of total billed charges,75% of total billed charges for outpatient setting,422,75,,337.6,percent of total billed charges,75% of total billed charges for outpatient setting,422,70,,337.6,percent of total billed charges,70% of total billed charges for outpatient setting,422,75,,337.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,35,,118.16,percent of total billed charges,35% of total billed charges for outpatient setting,329.16,78,,263.328,percent of total billed charges,78% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,350.26,83,,280.208,percent of total billed charges,83% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165.29,39.17,,132.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,422,
SUPPORT - REG ANKLE AIRGEL I0MM,2600048,CDM,274,RC,L4350,HCPCS,both,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94,70,,75.2,percent of total billed charges,70% of total billed charges for outpatient setting,94,70,,75.2,percent of total billed charges,70% of total billed charges for outpatient setting,94,70,,75.2,percent of total billed charges,70% of total billed charges for outpatient setting,94,75,,75.2,percent of total billed charges,75% of total billed charges for outpatient setting,94,75,,75.2,percent of total billed charges,75% of total billed charges for outpatient setting,94,70,,75.2,percent of total billed charges,70% of total billed charges for outpatient setting,94,75,,75.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,47,50,,37.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.9,94,
TUBE - 14FR SALEM SUMP,2600049,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
TUBE - 16FR SALEM SUMP,2600050,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
TUBE - 18FR SALEM SUMP,2600051,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
TUBE - 16FR GASTRO FEED W/Y PR,2600053,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
TUBE - 18FR GASTRO FEED W/Y PR,2600054,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
NEEDLE - 20GAX.75  PWR LOC,2600055,CDM,270,RC,,,outpatient,,,44.8,22.4,,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.68,35,,12.544,percent of total billed charges,35% of total billed charges for outpatient setting,34.94,78,,27.952,percent of total billed charges,78% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,37.18,83,,29.744,percent of total billed charges,83% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.54,39.17,,14.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.68,37.18,
NEEDLE - 20GAX1.25 GRIPPER,2600056,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
TRAY - 18FR FOLEY CATHETER,2600057,CDM,270,RC,,,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,35,,26.04,percent of total billed charges,35% of total billed charges for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.42,39.17,,29.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.55,77.19,
CATH - 8FR FOLEY,2600058,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CATH - 16FR FOLEY,2600059,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
CATH - 20FR FOLEY,2600060,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
CATH - 22FR FOLEY,2600061,CDM,270,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
ARMBOARD - INFANT 2X9,2600062,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
SCALPEL - #11,2600063,CDM,270,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
SCALPEL - #15,2600064,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TRAY - ADULT LUMBAR PUNCTURE,2600065,CDM,270,RC,,,outpatient,,,97,48.5,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.95,35,,27.16,percent of total billed charges,35% of total billed charges for outpatient setting,75.66,78,,60.528,percent of total billed charges,78% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.51,83,,64.408,percent of total billed charges,83% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,48.5,50,,38.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38,39.17,,30.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.95,80.51,
NEEDLE - 20GAX1  PWR LOC,2600066,CDM,270,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
COLLAR - BABY STIFNECK NO-NECK,2600067,CDM,270,RC,L0150,HCPCS,outpatient,,,113,56.5,,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,35,,31.64,percent of total billed charges,35% of total billed charges for outpatient setting,88.14,78,,70.512,percent of total billed charges,78% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.79,83,,75.032,percent of total billed charges,83% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.26,39.17,,35.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.55,93.79,
TUBE - NON-CONDUCT CONNECTING,2600068,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
TRAY - 14FR FOLEY CATH,2600069,CDM,270,RC,,,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.1,54.78,
TRAY - 14FR URETHRAL CATH DOVER OPEN,2600070,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
TRAY - SUTURE REMOVAL,2600071,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
CONNECTOR - 5-N-1 RIGID,2600072,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
REMOVER - STAPLE SKIN,2600073,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
TRAY - LACERATION,2600074,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
VALVE - LOPEZ ENTERAL,2600076,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DETECTOR - EASY CAP CO2,2600077,CDM,270,RC,,,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
TRAY - CENTRAL LINE DRESSING,2600078,CDM,270,RC,,,outpatient,,,23.8,11.9,,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.14,38.4,,7.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.14,38.4,,7.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.33,35,,6.664,percent of total billed charges,35% of total billed charges for outpatient setting,18.56,78,,14.848,percent of total billed charges,78% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,16.66,70,,13.328,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,75,,14.28,percent of total billed charges,75% of total billed charges for outpatient setting,19.75,83,,15.8,percent of total billed charges,83% of total billed charges for outpatient setting,11.9,50,,9.52,percent of total billed charges,50% of total billed charges for outpatient setting,11.9,50,,9.52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.32,39.17,,7.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.33,19.75,
KIT - CENTRAL VENOUS CATH,2600079,CDM,270,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
CATH - 6FR PEDS FOLEY,2600081,CDM,270,RC,,,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.4,35,,29.12,percent of total billed charges,35% of total billed charges for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.74,39.17,,32.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.4,86.32,
AIRWAY 32FR NASAL ROBERTAZZI,2600082,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
WALKER - SM BOOT,2600083,CDM,274,RC,L4386,HCPCS,both,,,280,140,,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98,35,,78.4,percent of total billed charges,35% of total billed charges for outpatient setting,218.4,78,,174.72,percent of total billed charges,78% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210,75,,168,percent of total billed charges,75% of total billed charges for outpatient setting,232.4,83,,185.92,percent of total billed charges,83% of total billed charges for outpatient setting,140,50,,112,percent of total billed charges,50% of total billed charges for outpatient setting,140,50,,112,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.67,39.17,,87.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98,280,
WALKER - MD BOOT,2600084,CDM,274,RC,L4386,HCPCS,both,,,280,140,,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.52,38.4,,86.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,280,70,,224,percent of total billed charges,70% of total billed charges for outpatient setting,280,75,,224,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98,35,,78.4,percent of total billed charges,35% of total billed charges for outpatient setting,218.4,78,,174.72,percent of total billed charges,78% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,196,70,,156.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210,75,,168,percent of total billed charges,75% of total billed charges for outpatient setting,232.4,83,,185.92,percent of total billed charges,83% of total billed charges for outpatient setting,140,50,,112,percent of total billed charges,50% of total billed charges for outpatient setting,140,50,,112,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.67,39.17,,87.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98,280,
WALKER - LG BOOT,2600085,CDM,274,RC,L4386,HCPCS,both,,,221,110.5,,154.7,70,,123.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.86,38.4,,67.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.86,38.4,,67.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,221,70,,176.8,percent of total billed charges,70% of total billed charges for outpatient setting,221,70,,176.8,percent of total billed charges,70% of total billed charges for outpatient setting,221,70,,176.8,percent of total billed charges,70% of total billed charges for outpatient setting,221,75,,176.8,percent of total billed charges,75% of total billed charges for outpatient setting,221,75,,176.8,percent of total billed charges,75% of total billed charges for outpatient setting,221,70,,176.8,percent of total billed charges,70% of total billed charges for outpatient setting,221,75,,176.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.35,35,,61.88,percent of total billed charges,35% of total billed charges for outpatient setting,172.38,78,,137.904,percent of total billed charges,78% of total billed charges for outpatient setting,154.7,70,,123.76,percent of total billed charges,70% of total billed charges for outpatient setting,154.7,70,,123.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.75,75,,132.6,percent of total billed charges,75% of total billed charges for outpatient setting,183.43,83,,146.744,percent of total billed charges,83% of total billed charges for outpatient setting,110.5,50,,88.4,percent of total billed charges,50% of total billed charges for outpatient setting,110.5,50,,88.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.56,39.17,,69.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,77.35,221,
IMMOB - XL KNEE SUPER SPLINT,2600086,CDM,274,RC,L1830,HCPCS,both,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,129,70,,103.2,percent of total billed charges,70% of total billed charges for outpatient setting,129,75,,103.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,64.5,50,,51.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,129,
SLING-SM CHILDS PRINT,2600087,CDM,274,RC,A4565,HCPCS,both,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19,70,,15.2,percent of total billed charges,70% of total billed charges for outpatient setting,19,70,,15.2,percent of total billed charges,70% of total billed charges for outpatient setting,19,70,,15.2,percent of total billed charges,70% of total billed charges for outpatient setting,19,75,,15.2,percent of total billed charges,75% of total billed charges for outpatient setting,19,75,,15.2,percent of total billed charges,75% of total billed charges for outpatient setting,19,70,,15.2,percent of total billed charges,70% of total billed charges for outpatient setting,19,75,,15.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,19,
INSTRUMENT - 12FR FRAZIER SUCT,2600089,CDM,270,RC,,,outpatient,,,25.2,12.6,,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.68,38.4,,7.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.68,38.4,,7.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.82,35,,7.056,percent of total billed charges,35% of total billed charges for outpatient setting,19.66,78,,15.728,percent of total billed charges,78% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,17.64,70,,14.112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,75,,15.12,percent of total billed charges,75% of total billed charges for outpatient setting,20.92,83,,16.736,percent of total billed charges,83% of total billed charges for outpatient setting,12.6,50,,10.08,percent of total billed charges,50% of total billed charges for outpatient setting,12.6,50,,10.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.87,39.17,,7.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.82,20.92,
BAG - 1000ML INFUSOR PRESSURE,2600090,CDM,270,RC,,,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28.7,68.06,
DEVICE - N.G. STATLOCK,2600091,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
DEVICE - SUCTION TUBE ATTACHME,2600092,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
ANGIOCATH - 22GA,2600093,CDM,270,RC,,,outpatient,,,15.4,7.7,,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.39,35,,4.312,percent of total billed charges,35% of total billed charges for outpatient setting,12.01,78,,9.608,percent of total billed charges,78% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,12.78,83,,10.224,percent of total billed charges,83% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.03,39.17,,4.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.39,12.78,
ANGIOCATH - 20GA,2600094,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
ANGIOCATH - 18GA,2600095,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
ANGIOCATH - 14GA,2600096,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
ANGIOCATH - 16GA,2600097,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
ANGIOCATH - 24GA,2600098,CDM,270,RC,,,outpatient,,,15.4,7.7,,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.91,38.4,,4.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.39,35,,4.312,percent of total billed charges,35% of total billed charges for outpatient setting,12.01,78,,9.608,percent of total billed charges,78% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,10.78,70,,8.624,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,75,,9.24,percent of total billed charges,75% of total billed charges for outpatient setting,12.78,83,,10.224,percent of total billed charges,83% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,7.7,50,,6.16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.03,39.17,,4.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.39,12.78,
KIT - 3 LUMEN 7FR CDC,2600099,CDM,270,RC,C1751,HCPCS,outpatient,,,349,174.5,,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.02,38.4,,107.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.02,38.4,,107.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.15,35,,97.72,percent of total billed charges,35% of total billed charges for outpatient setting,272.22,78,,217.776,percent of total billed charges,78% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,244.3,70,,195.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261.75,75,,209.4,percent of total billed charges,75% of total billed charges for outpatient setting,289.67,83,,231.736,percent of total billed charges,83% of total billed charges for outpatient setting,174.5,50,,139.6,percent of total billed charges,50% of total billed charges for outpatient setting,174.5,50,,139.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.7,39.17,,109.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.15,289.67,
ADHESIVE - .5G EXOFIN MICRO,2600101,CDM,270,RC,G0168,HCPCS,outpatient,,,141.4,70.7,,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.3,38.4,,43.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.3,38.4,,43.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,106.05,75,,84.84,percent of total billed charges,75% of total billed charges for outpatient setting,106.05,75,,84.84,percent of total billed charges,75% of total billed charges for outpatient setting,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,106.05,75,,84.84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.49,35,,39.592,percent of total billed charges,35% of total billed charges for outpatient setting,110.29,78,,88.232,percent of total billed charges,78% of total billed charges for outpatient setting,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,98.98,70,,79.184,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.05,75,,84.84,percent of total billed charges,75% of total billed charges for outpatient setting,117.36,83,,93.888,percent of total billed charges,83% of total billed charges for outpatient setting,70.7,50,,56.56,percent of total billed charges,50% of total billed charges for outpatient setting,70.7,50,,56.56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.39,39.17,,44.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49.49,117.36,
ARMBOARD - SMALL 9X3,2600102,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
DRESSING - UNNA BOOT W/CALOMIN,2600103,CDM,270,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
BANDAGE - 6  ESMARK,2600104,CDM,270,RC,,,outpatient,,,44.8,22.4,,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.2,38.4,,13.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.68,35,,12.544,percent of total billed charges,35% of total billed charges for outpatient setting,34.94,78,,27.952,percent of total billed charges,78% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,31.36,70,,25.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,75,,26.88,percent of total billed charges,75% of total billed charges for outpatient setting,37.18,83,,29.744,percent of total billed charges,83% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,22.4,50,,17.92,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.54,39.17,,14.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.68,37.18,
CATH - 28FR FOLEY,2600105,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
CANNULA - NEEDLELESS MED PREP,2600106,CDM,270,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
DRESSING - IOBAN 2 13X13,2600107,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CATH - 14FR FOLEY,2600108,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
SPLINT - MD LT PD COLLES,2600109,CDM,274,RC,L3999,HCPCS,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
KIT - 1CC ABG PROVENT,2600110,CDM,270,RC,,,outpatient,,,7.6,3.8,,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.92,38.4,,2.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.66,35,,2.128,percent of total billed charges,35% of total billed charges for outpatient setting,5.93,78,,4.744,percent of total billed charges,78% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,5.32,70,,4.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.7,75,,4.56,percent of total billed charges,75% of total billed charges for outpatient setting,6.31,83,,5.048,percent of total billed charges,83% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,3.8,50,,3.04,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.98,39.17,,2.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.66,6.31,
KIT - 10FR SUCTION CATH,2600111,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
NEBULIZER - MISTY MAX 10 DISP W/7FT TUB,2600112,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
HME - ADULT EXCHANGER,2600113,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
CUFF - #4 BP NEONATAL,2600114,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
PENCIL - HANDSWITCHING,2600115,CDM,270,RC,,,outpatient,,,29.4,14.7,,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.29,35,,8.232,percent of total billed charges,35% of total billed charges for outpatient setting,22.93,78,,18.344,percent of total billed charges,78% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,24.4,83,,19.52,percent of total billed charges,83% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,39.17,,9.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.29,24.4,
CANNULA - BLUNT PLASTIC,2600116,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
KIT - 12FR SUCTION CATH,2600117,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
KIT - 8FR SUCTION CATH,2600118,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
METER - PEAK FLOW,2600119,CDM,270,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
CHAMBER -  INSPIRA AEROSOL POCKET,2600120,CDM,270,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
CANNULA 02 NASAL 25FT,2600121,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
SET - TUBING VENTILATOR 1613,2600122,CDM,270,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
SYSTEM - SIMPULSE SOLO LAVAGE,2600123,CDM,270,RC,,,outpatient,,,163,81.5,,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.59,38.4,,50.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.05,35,,45.64,percent of total billed charges,35% of total billed charges for outpatient setting,127.14,78,,101.712,percent of total billed charges,78% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,114.1,70,,91.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.25,75,,97.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.29,83,,108.232,percent of total billed charges,83% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,81.5,50,,65.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.84,39.17,,51.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.05,135.29,
CATH - 10FR FOLEY,2600124,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TUBE - 12FR SALEM SUMP,2600125,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
SLING - XLG ARM,2600126,CDM,274,RC,A4565,HCPCS,both,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,23,70,,18.4,percent of total billed charges,70% of total billed charges for outpatient setting,23,75,,18.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,23,
CANNULA - PEDIATRIC # HUD1826,2600127,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
SPLINT - MD RT PD COLLES,2600128,CDM,274,RC,L3999,HCPCS,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
DRAPE - LAP CHOLE W/TROUGHS,2600129,CDM,270,RC,,,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,45.65,
CATH - 24FR FOLEY,2600130,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
EXERCISER - VOLUMETRIC 4000ML SPIROMETER,2600131,CDM,270,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
TUBE - SZ 8 CANNULA TRACH DISP,2600132,CDM,270,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
TRAY - PARA/THORACENTESIS,2600133,CDM,270,RC,,,outpatient,,,142,71,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.53,38.4,,43.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.7,35,,39.76,percent of total billed charges,35% of total billed charges for outpatient setting,110.76,78,,88.608,percent of total billed charges,78% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.86,83,,94.288,percent of total billed charges,83% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.62,39.17,,44.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49.7,117.86,
CUFF - #3 BP NEONATAL,2600134,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
EXTENSION SET 20,2600135,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
CANNULA - ADULT NASAL CUSHION,2600136,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
DISSECTOR - 5MM BLUNT TIP,2600137,CDM,270,RC,,,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,81.34,
CATH - 18FR SUCTION,2600138,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
TUBE - 5FR FEEDING INFANT,2600139,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
TUBE - 8FR INFANT FEEDING,2600140,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SENSOR - NEONATAL/ADULT OXYGEN,2600141,CDM,270,RC,,,outpatient,,,48.11,24.06,,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.47,38.4,,14.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.47,38.4,,14.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,36.08,75,,28.864,percent of total billed charges,75% of total billed charges for outpatient setting,36.08,75,,28.864,percent of total billed charges,75% of total billed charges for outpatient setting,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,36.08,75,,28.864,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,35,,13.472,percent of total billed charges,35% of total billed charges for outpatient setting,37.53,78,,30.024,percent of total billed charges,78% of total billed charges for outpatient setting,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,33.68,70,,26.944,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.08,75,,28.864,percent of total billed charges,75% of total billed charges for outpatient setting,39.93,83,,31.944,percent of total billed charges,83% of total billed charges for outpatient setting,24.06,50,,19.248,percent of total billed charges,50% of total billed charges for outpatient setting,24.06,50,,19.248,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.84,39.17,,15.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.93,
WARMER - INFANT HEEL W/TAPE,2600142,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CATH - 26FR 30CC FOLEY,2600143,CDM,270,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
CATH - 30FR  FOLEY,2600144,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
AMBU - PEDIATRIC,2600146,CDM,270,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
SPLINT - XLG LT COCKUP,2600148,CDM,274,RC,L3908,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
RESTRAINT - SM VEST POSEY,2600149,CDM,270,RC,E0710,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.8,73.04,
CATH - 24FR STR THORACIC,2600150,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CATH - 36FR STR THORACIC,2600151,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CATH - 32FR STR THORACIC,2600152,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
ENDOLOOP - COATED VICRYL 0 18,2600153,CDM,270,RC,,,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.6,63.08,
CATH - 20FR STR THORACIC,2600154,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
AMBU - INFANT/NEO,2600155,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
PILLOW - ABDUCTION LG,2600156,CDM,270,RC,,,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.45,72.21,
SCISSOR - 5MM CURVED ENDOPATH,2600157,CDM,270,RC,,,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.3,35,,72.24,percent of total billed charges,35% of total billed charges for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.05,39.17,,80.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,90.3,214.14,
STAPLER - VISISTAT 35W,2600158,CDM,270,RC,,,outpatient,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,35,,15.96,percent of total billed charges,35% of total billed charges for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.33,39.17,,17.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.95,47.31,
KIT - 1000ML PREFILLED NEBULIZ,2600159,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
NEBULIZER - UNIHEART,2600160,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
AMBU - ADULT,2600161,CDM,270,RC,,,outpatient,,,35.45,17.73,,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.61,38.4,,10.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.61,38.4,,10.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.41,35,,9.928,percent of total billed charges,35% of total billed charges for outpatient setting,27.65,78,,22.12,percent of total billed charges,78% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,24.82,70,,19.856,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.59,75,,21.272,percent of total billed charges,75% of total billed charges for outpatient setting,29.42,83,,23.536,percent of total billed charges,83% of total billed charges for outpatient setting,17.73,50,,14.184,percent of total billed charges,50% of total billed charges for outpatient setting,17.73,50,,14.184,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.88,39.17,,11.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.41,29.42,
SNARE - 25MM OLYMPUS REGULAR,2600162,CDM,270,RC,,,outpatient,,,177.8,88.9,,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.28,38.4,,54.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.28,38.4,,54.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.23,35,,49.784,percent of total billed charges,35% of total billed charges for outpatient setting,138.68,78,,110.944,percent of total billed charges,78% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,124.46,70,,99.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.35,75,,106.68,percent of total billed charges,75% of total billed charges for outpatient setting,147.57,83,,118.056,percent of total billed charges,83% of total billed charges for outpatient setting,88.9,50,,71.12,percent of total billed charges,50% of total billed charges for outpatient setting,88.9,50,,71.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,39.17,,55.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,62.23,147.57,
FORCEP - HOT BIOPSY,2600163,CDM,270,RC,,,outpatient,,,274.4,137.2,,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.37,38.4,,84.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.37,38.4,,84.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,75,,164.64,percent of total billed charges,75% of total billed charges for outpatient setting,205.8,75,,164.64,percent of total billed charges,75% of total billed charges for outpatient setting,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,205.8,75,,164.64,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.04,35,,76.832,percent of total billed charges,35% of total billed charges for outpatient setting,214.03,78,,171.224,percent of total billed charges,78% of total billed charges for outpatient setting,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,192.08,70,,153.664,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.8,75,,164.64,percent of total billed charges,75% of total billed charges for outpatient setting,227.75,83,,182.2,percent of total billed charges,83% of total billed charges for outpatient setting,137.2,50,,109.76,percent of total billed charges,50% of total billed charges for outpatient setting,137.2,50,,109.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.48,39.17,,85.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,96.04,227.75,
COLLAR - PEDIATRIC STIFFNECK,2600164,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
CATH  - 14FR SUCTION,2600165,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
MASK - ADULT VENTI,2600166,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
MASK  -  NRB ADULT,2600167,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
MASK - ADULT AEROSOL,2600168,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
MASK - TRACH,2600169,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
MASK - MD ADULT FACE,2600170,CDM,270,RC,,,outpatient,,,32.2,16.1,,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.36,38.4,,9.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.36,38.4,,9.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,24.15,75,,19.32,percent of total billed charges,75% of total billed charges for outpatient setting,24.15,75,,19.32,percent of total billed charges,75% of total billed charges for outpatient setting,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,24.15,75,,19.32,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.27,35,,9.016,percent of total billed charges,35% of total billed charges for outpatient setting,25.12,78,,20.096,percent of total billed charges,78% of total billed charges for outpatient setting,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,22.54,70,,18.032,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.15,75,,19.32,percent of total billed charges,75% of total billed charges for outpatient setting,26.73,83,,21.384,percent of total billed charges,83% of total billed charges for outpatient setting,16.1,50,,12.88,percent of total billed charges,50% of total billed charges for outpatient setting,16.1,50,,12.88,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.61,39.17,,10.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.27,26.73,
WAFER - 4  OSTOMY W/ FLANGE,2600171,CDM,274,RC,A4415,HCPCS,both,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54,70,,43.2,percent of total billed charges,70% of total billed charges for outpatient setting,54,70,,43.2,percent of total billed charges,70% of total billed charges for outpatient setting,54,70,,43.2,percent of total billed charges,70% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,54,70,,43.2,percent of total billed charges,70% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27,54,
POUCH - 4  DRAINABLE OSTOMY,2600172,CDM,274,RC,A5063,HCPCS,both,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,70,,36,percent of total billed charges,70% of total billed charges for outpatient setting,45,70,,36,percent of total billed charges,70% of total billed charges for outpatient setting,45,70,,36,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,70,,36,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,45,
PASTE - 2 OZ OSTOMY,2600173,CDM,274,RC,A4406,HCPCS,both,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,4.59,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.82,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.59,12,
CATH - 16FR LF FOLEY,2600174,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SPLINT - MD POSTERIOR TIB/FIB,2600178,CDM,274,RC,L1930,HCPCS,both,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.1,246,
SPLINT - LG POSTERIOR TIB/FIB,2600179,CDM,274,RC,L1930,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SPLINT - SM POSTERIOR TIB/FIB,2600180,CDM,274,RC,L1930,HCPCS,both,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,70,,196.8,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,123,50,,98.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.1,246,
TRAY - 16FR FOLEY CATH,2600181,CDM,270,RC,,,outpatient,,,55.7,27.85,,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.39,38.4,,17.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.39,38.4,,17.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,35,,15.6,percent of total billed charges,35% of total billed charges for outpatient setting,43.45,78,,34.76,percent of total billed charges,78% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,38.99,70,,31.192,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.78,75,,33.424,percent of total billed charges,75% of total billed charges for outpatient setting,46.23,83,,36.984,percent of total billed charges,83% of total billed charges for outpatient setting,27.85,50,,22.28,percent of total billed charges,50% of total billed charges for outpatient setting,27.85,50,,22.28,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.82,39.17,,17.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.5,46.23,
ELECTRODE - PED ECG MEDITRACE,2600182,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
SENSOR - INFANT OXYGEN,2600184,CDM,270,RC,,,outpatient,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.95,35,,21.56,percent of total billed charges,35% of total billed charges for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,38.5,50,,30.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.16,39.17,,24.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.95,63.91,
TUBE - SZ6.5  CANNULA TRACH DISP,2600185,CDM,270,RC,,,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.9,61.42,
CANNULA - SZ 6 INTERTRACH DISP,2600186,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
CUTTER - LINEAR 45MM ENDOSCOPI,2600187,CDM,270,RC,,,outpatient,,,429,214.5,,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.74,38.4,,131.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,164.74,38.4,,131.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,321.75,75,,257.4,percent of total billed charges,75% of total billed charges for outpatient setting,321.75,75,,257.4,percent of total billed charges,75% of total billed charges for outpatient setting,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,321.75,75,,257.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.15,35,,120.12,percent of total billed charges,35% of total billed charges for outpatient setting,334.62,78,,267.696,percent of total billed charges,78% of total billed charges for outpatient setting,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,300.3,70,,240.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.75,75,,257.4,percent of total billed charges,75% of total billed charges for outpatient setting,356.07,83,,284.856,percent of total billed charges,83% of total billed charges for outpatient setting,214.5,50,,171.6,percent of total billed charges,50% of total billed charges for outpatient setting,214.5,50,,171.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.03,39.17,,134.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.15,356.07,
TROCAR - COR47 12X100 KII BLN,2600188,CDM,270,RC,,,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.85,35,,53.48,percent of total billed charges,35% of total billed charges for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.81,39.17,,59.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.85,158.53,
BLANKET - FB BAIR HUGGER,2600189,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
KIT - BAIR PAWS FLEX GOWN,2600190,CDM,270,RC,,,outpatient,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.05,35,,34.44,percent of total billed charges,35% of total billed charges for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.17,39.17,,38.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.05,102.09,
CANNULA - SZ 10 INNERTRACH DIS,2600191,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
CANNULA - SZ 4 INNERTRACH DISP,2600192,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
DRAIN - CHEST OASIS,2600195,CDM,270,RC,,,outpatient,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,53.12,
SYSTEM - VIBRATORY THERAPY ACAPELLA,2600196,CDM,270,RC,,,outpatient,,,186,93,,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.42,38.4,,57.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.1,35,,52.08,percent of total billed charges,35% of total billed charges for outpatient setting,145.08,78,,116.064,percent of total billed charges,78% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,130.2,70,,104.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.5,75,,111.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.38,83,,123.504,percent of total billed charges,83% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,93,50,,74.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.85,39.17,,58.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,65.1,154.38,
DRESSING - 4X4 OPTILOCK,2600197,CDM,270,RC,,,outpatient,,,5.3,2.65,,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.04,38.4,,1.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.04,38.4,,1.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,3.98,75,,3.184,percent of total billed charges,75% of total billed charges for outpatient setting,3.98,75,,3.184,percent of total billed charges,75% of total billed charges for outpatient setting,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,3.98,75,,3.184,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.86,35,,1.488,percent of total billed charges,35% of total billed charges for outpatient setting,4.13,78,,3.304,percent of total billed charges,78% of total billed charges for outpatient setting,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,3.71,70,,2.968,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.98,75,,3.184,percent of total billed charges,75% of total billed charges for outpatient setting,4.4,83,,3.52,percent of total billed charges,83% of total billed charges for outpatient setting,2.65,50,,2.12,percent of total billed charges,50% of total billed charges for outpatient setting,2.65,50,,2.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.08,39.17,,1.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.86,4.4,
PROTECTOR - HEELMEDIX BASIC HEEL,2600198,CDM,270,RC,,,outpatient,,,65.63,32.82,,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.2,38.4,,20.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.2,38.4,,20.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,49.22,75,,39.376,percent of total billed charges,75% of total billed charges for outpatient setting,49.22,75,,39.376,percent of total billed charges,75% of total billed charges for outpatient setting,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,49.22,75,,39.376,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.97,35,,18.376,percent of total billed charges,35% of total billed charges for outpatient setting,51.19,78,,40.952,percent of total billed charges,78% of total billed charges for outpatient setting,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,45.94,70,,36.752,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.22,75,,39.376,percent of total billed charges,75% of total billed charges for outpatient setting,54.47,83,,43.576,percent of total billed charges,83% of total billed charges for outpatient setting,32.82,50,,26.256,percent of total billed charges,50% of total billed charges for outpatient setting,32.82,50,,26.256,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.7,39.17,,20.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.97,54.47,
APPLIER - 5MM ENDOCLIP,2600199,CDM,270,RC,,,outpatient,,,602,301,,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231.17,38.4,,184.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231.17,38.4,,184.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,75,,361.2,percent of total billed charges,75% of total billed charges for outpatient setting,451.5,75,,361.2,percent of total billed charges,75% of total billed charges for outpatient setting,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,75,,361.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,210.7,35,,168.56,percent of total billed charges,35% of total billed charges for outpatient setting,469.56,78,,375.648,percent of total billed charges,78% of total billed charges for outpatient setting,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,421.4,70,,337.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,451.5,75,,361.2,percent of total billed charges,75% of total billed charges for outpatient setting,499.66,83,,399.728,percent of total billed charges,83% of total billed charges for outpatient setting,301,50,,240.8,percent of total billed charges,50% of total billed charges for outpatient setting,301,50,,240.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.79,39.17,,188.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,210.7,499.66,
SYSTEM - CD003 INZII RETRVL 5M,2600200,CDM,270,RC,,,outpatient,,,347,173.5,,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.25,38.4,,106.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.25,38.4,,106.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.25,75,,208.2,percent of total billed charges,75% of total billed charges for outpatient setting,260.25,75,,208.2,percent of total billed charges,75% of total billed charges for outpatient setting,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.25,75,,208.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.45,35,,97.16,percent of total billed charges,35% of total billed charges for outpatient setting,270.66,78,,216.528,percent of total billed charges,78% of total billed charges for outpatient setting,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,242.9,70,,194.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,260.25,75,,208.2,percent of total billed charges,75% of total billed charges for outpatient setting,288.01,83,,230.408,percent of total billed charges,83% of total billed charges for outpatient setting,173.5,50,,138.8,percent of total billed charges,50% of total billed charges for outpatient setting,173.5,50,,138.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.92,39.17,,108.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,121.45,288.01,
DEVICE - CATHETER SECUREMENT,2600201,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
BAG - URINARY DRAINAGE,2600202,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
KIT - PNEUMOTHORAX,2600203,CDM,270,RC,,,outpatient,,,357,178.5,,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.09,38.4,,109.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.09,38.4,,109.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,267.75,75,,214.2,percent of total billed charges,75% of total billed charges for outpatient setting,267.75,75,,214.2,percent of total billed charges,75% of total billed charges for outpatient setting,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,267.75,75,,214.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.95,35,,99.96,percent of total billed charges,35% of total billed charges for outpatient setting,278.46,78,,222.768,percent of total billed charges,78% of total billed charges for outpatient setting,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,249.9,70,,199.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,267.75,75,,214.2,percent of total billed charges,75% of total billed charges for outpatient setting,296.31,83,,237.048,percent of total billed charges,83% of total billed charges for outpatient setting,178.5,50,,142.8,percent of total billed charges,50% of total billed charges for outpatient setting,178.5,50,,142.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.83,39.17,,111.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,124.95,296.31,
SKINSLEEVE - MD ARM LIGHT TONE,2600204,CDM,270,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
SKINSLEEVE - LG ARM LIGHT TOME,2600205,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
TUBING - O2 CONNECTING,2600207,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
KIT - 24FR BALLOON SLG 3.0CM,2600208,CDM,270,RC,,,outpatient,,,164,82,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.4,35,,45.92,percent of total billed charges,35% of total billed charges for outpatient setting,127.92,78,,102.336,percent of total billed charges,78% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,136.12,83,,108.896,percent of total billed charges,83% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.24,39.17,,51.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.4,136.12,
DRESSING - 4 X4 EXUDERM SATIN HYDROCOLL,2600209,CDM,270,RC,,,outpatient,,,3.72,1.86,,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.43,38.4,,1.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.43,38.4,,1.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.79,75,,2.232,percent of total billed charges,75% of total billed charges for outpatient setting,2.79,75,,2.232,percent of total billed charges,75% of total billed charges for outpatient setting,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.79,75,,2.232,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.3,35,,1.04,percent of total billed charges,35% of total billed charges for outpatient setting,2.9,78,,2.32,percent of total billed charges,78% of total billed charges for outpatient setting,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,2.6,70,,2.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.79,75,,2.232,percent of total billed charges,75% of total billed charges for outpatient setting,3.09,83,,2.472,percent of total billed charges,83% of total billed charges for outpatient setting,1.86,50,,1.488,percent of total billed charges,50% of total billed charges for outpatient setting,1.86,50,,1.488,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.46,39.17,,1.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.3,3.09,
BAG - LG LEG DISPOZ-A,2600210,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
BAG - AEROSOL DRAIN,2600211,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
MASK - O2 ADULT FACE,2600212,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
TUBE - CANNULA TRACH SZ 4,2600213,CDM,270,RC,,,outpatient,,,1298,649,,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.3,35,,363.44,percent of total billed charges,35% of total billed charges for outpatient setting,1012.44,78,,809.952,percent of total billed charges,78% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,1077.34,83,,861.872,percent of total billed charges,83% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,508.4,39.17,,406.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,454.3,1077.34,
SET - COLLECTION DISPOSABLE,2600214,CDM,270,RC,,,outpatient,,,49,24.5,,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.82,38.4,,15.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.15,35,,13.72,percent of total billed charges,35% of total billed charges for outpatient setting,38.22,78,,30.576,percent of total billed charges,78% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,34.3,70,,27.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,75,,29.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.67,83,,32.536,percent of total billed charges,83% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,24.5,50,,19.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,39.17,,15.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.15,40.67,
INSTRUMENT - POOLE SUCTION,2600216,CDM,270,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
TUBING - INSUFFLATOR STANDARD,2600217,CDM,270,RC,,,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.4,69.72,
SET - TUBE FLOSTEADY ARTHRO,2600218,CDM,270,RC,,,outpatient,,,253,126.5,,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.15,38.4,,77.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.15,38.4,,77.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.55,35,,70.84,percent of total billed charges,35% of total billed charges for outpatient setting,197.34,78,,157.872,percent of total billed charges,78% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,177.1,70,,141.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.75,75,,151.8,percent of total billed charges,75% of total billed charges for outpatient setting,209.99,83,,167.992,percent of total billed charges,83% of total billed charges for outpatient setting,126.5,50,,101.2,percent of total billed charges,50% of total billed charges for outpatient setting,126.5,50,,101.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.09,39.17,,79.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,88.55,209.99,
TUBING - POOLE TIP SUCTION,2600219,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
CANNULA & SEAL - CTS02S ADV FX,2600220,CDM,270,RC,,,outpatient,,,71.4,35.7,,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.42,38.4,,21.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.42,38.4,,21.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.99,35,,19.992,percent of total billed charges,35% of total billed charges for outpatient setting,55.69,78,,44.552,percent of total billed charges,78% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,49.98,70,,39.984,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.55,75,,42.84,percent of total billed charges,75% of total billed charges for outpatient setting,59.26,83,,47.408,percent of total billed charges,83% of total billed charges for outpatient setting,35.7,50,,28.56,percent of total billed charges,50% of total billed charges for outpatient setting,35.7,50,,28.56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.97,39.17,,22.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.99,59.26,
FIOS - CTF04 KII5X100 ZTHRU HN,2600221,CDM,270,RC,,,outpatient,,,127.4,63.7,,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.92,38.4,,39.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.59,35,,35.672,percent of total billed charges,35% of total billed charges for outpatient setting,99.37,78,,79.496,percent of total billed charges,78% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,89.18,70,,71.344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.55,75,,76.44,percent of total billed charges,75% of total billed charges for outpatient setting,105.74,83,,84.592,percent of total billed charges,83% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,63.7,50,,50.96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.9,39.17,,39.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.59,105.74,
KIT - 18FR 2.7 MIC-KEY LOW PRO,2600222,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRESSING - 4X6 SOFSORB,2600224,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
DRESSING - 6X9 SOFSORB,2600225,CDM,270,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
TRAY - ER SUTURE REMOVAL,2600226,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
DRESSING - 3X3 GENTLE BRDR OPTIFOAM,2600227,CDM,270,RC,,,outpatient,,,2.79,1.4,,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.07,38.4,,0.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.07,38.4,,0.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,2.09,75,,1.672,percent of total billed charges,75% of total billed charges for outpatient setting,2.09,75,,1.672,percent of total billed charges,75% of total billed charges for outpatient setting,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,2.09,75,,1.672,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.98,35,,0.784,percent of total billed charges,35% of total billed charges for outpatient setting,2.18,78,,1.744,percent of total billed charges,78% of total billed charges for outpatient setting,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,1.95,70,,1.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.09,75,,1.672,percent of total billed charges,75% of total billed charges for outpatient setting,2.32,83,,1.856,percent of total billed charges,83% of total billed charges for outpatient setting,1.4,50,,1.12,percent of total billed charges,50% of total billed charges for outpatient setting,1.4,50,,1.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,39.17,,0.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.98,2.32,
DRESSING - 4X4 GENTLE BORDER OPTIFO,2600228,CDM,270,RC,,,outpatient,,,7.28,3.64,,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,38.4,,2.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,38.4,,2.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.46,75,,4.368,percent of total billed charges,75% of total billed charges for outpatient setting,5.46,75,,4.368,percent of total billed charges,75% of total billed charges for outpatient setting,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.46,75,,4.368,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.55,35,,2.04,percent of total billed charges,35% of total billed charges for outpatient setting,5.68,78,,4.544,percent of total billed charges,78% of total billed charges for outpatient setting,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,5.1,70,,4.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.46,75,,4.368,percent of total billed charges,75% of total billed charges for outpatient setting,6.04,83,,4.832,percent of total billed charges,83% of total billed charges for outpatient setting,3.64,50,,2.912,percent of total billed charges,50% of total billed charges for outpatient setting,3.64,50,,2.912,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.86,39.17,,2.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.55,6.04,
DRESSING - 6X6 GENTLE BRDR OPTIFOAM,2600229,CDM,270,RC,,,outpatient,,,12.35,6.18,,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.74,38.4,,3.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.74,38.4,,3.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,9.26,75,,7.408,percent of total billed charges,75% of total billed charges for outpatient setting,9.26,75,,7.408,percent of total billed charges,75% of total billed charges for outpatient setting,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,9.26,75,,7.408,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.32,35,,3.456,percent of total billed charges,35% of total billed charges for outpatient setting,9.63,78,,7.704,percent of total billed charges,78% of total billed charges for outpatient setting,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,8.65,70,,6.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.26,75,,7.408,percent of total billed charges,75% of total billed charges for outpatient setting,10.25,83,,8.2,percent of total billed charges,83% of total billed charges for outpatient setting,6.18,50,,4.944,percent of total billed charges,50% of total billed charges for outpatient setting,6.18,50,,4.944,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.83,39.17,,3.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.32,10.25,
DRESSING - 7X7 SACRAL OPTIFOAM GENTLE,2600230,CDM,270,RC,,,outpatient,,,16.18,8.09,,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.21,38.4,,4.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.21,38.4,,4.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,12.14,75,,9.712,percent of total billed charges,75% of total billed charges for outpatient setting,12.14,75,,9.712,percent of total billed charges,75% of total billed charges for outpatient setting,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,12.14,75,,9.712,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.66,35,,4.528,percent of total billed charges,35% of total billed charges for outpatient setting,12.62,78,,10.096,percent of total billed charges,78% of total billed charges for outpatient setting,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,11.33,70,,9.064,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,75,,9.712,percent of total billed charges,75% of total billed charges for outpatient setting,13.43,83,,10.744,percent of total billed charges,83% of total billed charges for outpatient setting,8.09,50,,6.472,percent of total billed charges,50% of total billed charges for outpatient setting,8.09,50,,6.472,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.33,39.17,,5.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.66,13.43,
HOLDER - ADULT ENDOTRACH TUBE THOMAS,2600231,CDM,270,RC,A7526,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29,48.14,
WATER - 340ML STERILE,2600232,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
TUBE - 5.0 MM ET CUFFED,2600233,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
TUBE - 5.5 MM ET UNCUFFED,2600234,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
TUBE - 6.0 MM ET CUFFED,2600235,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
TUBE - 6.5 MM ET CUFFED,2600236,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
TUBE - 7.0 MM ET CUFFED,2600237,CDM,270,RC,,,outpatient,,,29.4,14.7,,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.29,38.4,,9.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.29,35,,8.232,percent of total billed charges,35% of total billed charges for outpatient setting,22.93,78,,18.344,percent of total billed charges,78% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,20.58,70,,16.464,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,75,,17.64,percent of total billed charges,75% of total billed charges for outpatient setting,24.4,83,,19.52,percent of total billed charges,83% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,14.7,50,,11.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,39.17,,9.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.29,24.4,
TUBE - 7.5 MM ET CUFFED,2600238,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
TUBE - 8.0 MM ET CUFFED,2600239,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
TUBE - 8.5 MM ET CUFFED,2600240,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
INJECTION GUN - PEDIATRIC,2600241,CDM,270,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,167,50,,133.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,277.22,
TRAP - 40FR MUCOUS SPECIMAN,2600243,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
TRAP - 80FR MUCOUS SPECIMAN,2600244,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
BINDER - LG 36-42  ABD/BREAST,2600245,CDM,274,RC,A9270,HCPCS,both,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,61,70,,48.8,percent of total billed charges,70% of total billed charges for outpatient setting,61,75,,48.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,61,
BINDER - XL 42-48  ABD/BREAST,2600246,CDM,274,RC,A9270,HCPCS,both,,,64,32,,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.58,38.4,,19.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64,70,,51.2,percent of total billed charges,70% of total billed charges for outpatient setting,64,70,,51.2,percent of total billed charges,70% of total billed charges for outpatient setting,64,70,,51.2,percent of total billed charges,70% of total billed charges for outpatient setting,64,75,,51.2,percent of total billed charges,75% of total billed charges for outpatient setting,64,75,,51.2,percent of total billed charges,75% of total billed charges for outpatient setting,64,70,,51.2,percent of total billed charges,70% of total billed charges for outpatient setting,64,75,,51.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.4,35,,17.92,percent of total billed charges,35% of total billed charges for outpatient setting,49.92,78,,39.936,percent of total billed charges,78% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,44.8,70,,35.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,75,,38.4,percent of total billed charges,75% of total billed charges for outpatient setting,53.12,83,,42.496,percent of total billed charges,83% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,32,50,,25.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.07,39.17,,20.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.4,64,
BINDER - XXL46-62  ABD/BREAST,2600247,CDM,274,RC,A9270,HCPCS,both,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46,70,,36.8,percent of total billed charges,70% of total billed charges for outpatient setting,46,70,,36.8,percent of total billed charges,70% of total billed charges for outpatient setting,46,70,,36.8,percent of total billed charges,70% of total billed charges for outpatient setting,46,75,,36.8,percent of total billed charges,75% of total billed charges for outpatient setting,46,75,,36.8,percent of total billed charges,75% of total billed charges for outpatient setting,46,70,,36.8,percent of total billed charges,70% of total billed charges for outpatient setting,46,75,,36.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,46,
TUBE - 28FR GASTRO FEED W/YPRT,2600248,CDM,270,RC,,,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
PACK - OB III AURORA,2600250,CDM,270,RC,,,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
NEEDLE - 23GA POSI-STOP COLONS,2600254,CDM,270,RC,,,outpatient,,,282.8,141.4,,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.6,38.4,,86.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.6,38.4,,86.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,75,,169.68,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,75,,169.68,percent of total billed charges,75% of total billed charges for outpatient setting,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,75,,169.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.98,35,,79.184,percent of total billed charges,35% of total billed charges for outpatient setting,220.58,78,,176.464,percent of total billed charges,78% of total billed charges for outpatient setting,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,197.96,70,,158.368,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,212.1,75,,169.68,percent of total billed charges,75% of total billed charges for outpatient setting,234.72,83,,187.776,percent of total billed charges,83% of total billed charges for outpatient setting,141.4,50,,113.12,percent of total billed charges,50% of total billed charges for outpatient setting,141.4,50,,113.12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.77,39.17,,88.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.98,234.72,
CANNULA&SEAL - CFSO2 5X100 KII,2600255,CDM,270,RC,,,outpatient,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,35,,14.28,percent of total billed charges,35% of total billed charges for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,39.17,,15.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.85,42.33,
INJECTION GUN - ADULT,2600256,CDM,270,RC,,,outpatient,,,475,237.5,,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.4,38.4,,145.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182.4,38.4,,145.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.25,35,,133,percent of total billed charges,35% of total billed charges for outpatient setting,370.5,78,,296.4,percent of total billed charges,78% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,394.25,83,,315.4,percent of total billed charges,83% of total billed charges for outpatient setting,237.5,50,,190,percent of total billed charges,50% of total billed charges for outpatient setting,237.5,50,,190,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,186.05,39.17,,148.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,166.25,394.25,
TRAY - PED/INFANT SAFE-T LUMBA,2600257,CDM,270,RC,,,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21,49.8,
KIT - 20FR PEG SAFETY KANGAROO,2600258,CDM,270,RC,,,outpatient,,,158,79,,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.67,38.4,,48.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.3,35,,44.24,percent of total billed charges,35% of total billed charges for outpatient setting,123.24,78,,98.592,percent of total billed charges,78% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,110.6,70,,88.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,118.5,75,,94.8,percent of total billed charges,75% of total billed charges for outpatient setting,131.14,83,,104.912,percent of total billed charges,83% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,79,50,,63.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.88,39.17,,49.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,55.3,131.14,
CATH - 18FR FOLEY,2600259,CDM,270,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
INTRODUCER - 15FR ADULT BOUGIE,2600264,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
TRAY - BREAST LOCALIZATION,2600265,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
DETECTOR - PEDI-CAP CO2,2600266,CDM,270,RC,,,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,36.52,
INTRODUCER - 10FR PEDI BOUGIE,2600267,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
AIRQ - 1.5 INTUBATING LMA  TERMINATED,2600268,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
AIRQ - 3.5 INTUBATING LMA,2600270,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
AIRQ - 4.5 INTUBATING LMA,2600271,CDM,270,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
CATH - 12FR STR THORACIC,2600272,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SHOE - LG MALE POSTOP,2600273,CDM,270,RC,L3260,HCPCS,outpatient,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,35,,14.28,percent of total billed charges,35% of total billed charges for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,39.17,,15.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.85,42.33,
SHOE - MD MALE POSTOP,2600274,CDM,270,RC,L3260,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
SHOE - SM MALE POSTOP,2600275,CDM,270,RC,L3260,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
SHOE - LG FEMALE POSTOP,2600276,CDM,270,RC,L3260,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
SHOE - MD FEMALE POSTOP,2600277,CDM,270,RC,L3260,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
SHOE - SM FEMALE POSTOP,2600278,CDM,270,RC,L3260,HCPCS,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
ELECTRODE - PEDIATRIC EDGEQUIK COMBO RTS,2600280,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
TUBING - FLOSTEADY IRR LAPRO,2600281,CDM,270,RC,,,outpatient,,,242,121,,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.93,38.4,,74.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.7,35,,67.76,percent of total billed charges,35% of total billed charges for outpatient setting,188.76,78,,151.008,percent of total billed charges,78% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.86,83,,160.688,percent of total billed charges,83% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.79,39.17,,75.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84.7,200.86,
STYLET - 14FR INTUBATING,2600282,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
MASK - MD AF541 BIPAP,2600283,CDM,270,RC,A7030,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,74.7,
MASK - LG AF541 BIBPAP,2600284,CDM,270,RC,A7030,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,74.7,
DRESSING - 4 X4.25  PURACOL,2600285,CDM,270,RC,,,outpatient,,,18.16,9.08,,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.97,38.4,,5.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.97,38.4,,5.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,13.62,75,,10.896,percent of total billed charges,75% of total billed charges for outpatient setting,13.62,75,,10.896,percent of total billed charges,75% of total billed charges for outpatient setting,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,13.62,75,,10.896,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.36,35,,5.088,percent of total billed charges,35% of total billed charges for outpatient setting,14.16,78,,11.328,percent of total billed charges,78% of total billed charges for outpatient setting,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,12.71,70,,10.168,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.62,75,,10.896,percent of total billed charges,75% of total billed charges for outpatient setting,15.07,83,,12.056,percent of total billed charges,83% of total billed charges for outpatient setting,9.08,50,,7.264,percent of total billed charges,50% of total billed charges for outpatient setting,9.08,50,,7.264,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.11,39.17,,5.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.36,15.07,
DRESSING - 2 X2  PURACOL,2600286,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
ELECTRODE - ADULT EDGE QUIK COMBO RTS,2600288,CDM,270,RC,,,outpatient,,,104,52,,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.94,38.4,,31.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.4,35,,29.12,percent of total billed charges,35% of total billed charges for outpatient setting,81.12,78,,64.896,percent of total billed charges,78% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,72.8,70,,58.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78,75,,62.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.32,83,,69.056,percent of total billed charges,83% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,52,50,,41.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.74,39.17,,32.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.4,86.32,
DRESSING - 4X4 OPTIFOAM ADHESI,2600289,CDM,270,RC,,,outpatient,,,12.66,6.33,,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.86,38.4,,3.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.86,38.4,,3.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.43,35,,3.544,percent of total billed charges,35% of total billed charges for outpatient setting,9.87,78,,7.896,percent of total billed charges,78% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,8.86,70,,7.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.5,75,,7.6,percent of total billed charges,75% of total billed charges for outpatient setting,10.51,83,,8.408,percent of total billed charges,83% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,6.33,50,,5.064,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.96,39.17,,3.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.43,10.51,
STETHOSCOPE - SINGLE PATIENT USE BLUE,2600290,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
WRAP - 4  COBAN TAN STERILE,2600291,CDM,270,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
C-COLLAR - ADULT ADJUST PERFIT,2600293,CDM,270,RC,,,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.6,63.08,
SPLINT - LG LT WRIST,2600294,CDM,270,RC,,,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,71.38,
TUBE - 24FR GASTRO FEED W/YPRT,2600295,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
TUBE - SZ 4 CANNULA TRACH,2600296,CDM,270,RC,,,outpatient,,,131,65.5,,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.85,35,,36.68,percent of total billed charges,35% of total billed charges for outpatient setting,102.18,78,,81.744,percent of total billed charges,78% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,108.73,83,,86.984,percent of total billed charges,83% of total billed charges for outpatient setting,65.5,50,,52.4,percent of total billed charges,50% of total billed charges for outpatient setting,65.5,50,,52.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.31,39.17,,41.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.85,108.73,
SPLINT - SM FROG,2600297,CDM,274,RC,A4570,HCPCS,both,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,7,
SPLINT - MD FROG,2600298,CDM,274,RC,A4570,HCPCS,both,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6,70,,4.8,percent of total billed charges,70% of total billed charges for outpatient setting,6,70,,4.8,percent of total billed charges,70% of total billed charges for outpatient setting,6,70,,4.8,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,70,,4.8,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,6,
SPLINT - LG FROG,2600299,CDM,274,RC,A4570,HCPCS,both,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,75,,5.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,7,
SPLINT - SM BASEBALL 3-3/4,2600300,CDM,274,RC,A4570,HCPCS,both,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,9,
SPLINT - MD BASEBALL 4-1/4,2600301,CDM,274,RC,A4570,HCPCS,both,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,70,,9.6,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,12,
SPLINT - LG BASEBALL 4-3/4,2600302,CDM,274,RC,A4570,HCPCS,both,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,70,,7.2,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,9,
DRESSING - 3X3 BASIC OPTIFOAM,2600305,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
PAD - ADULT DEFIB 10KG,2600307,CDM,270,RC,,,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,35,,26.88,percent of total billed charges,35% of total billed charges for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.6,39.17,,30.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.6,79.68,
PAD - PED DEFIB LIFEPACK15,2600308,CDM,270,RC,,,outpatient,,,96,48,,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.86,38.4,,29.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.6,35,,26.88,percent of total billed charges,35% of total billed charges for outpatient setting,74.88,78,,59.904,percent of total billed charges,78% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,67.2,70,,53.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72,75,,57.6,percent of total billed charges,75% of total billed charges for outpatient setting,79.68,83,,63.744,percent of total billed charges,83% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,48,50,,38.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.6,39.17,,30.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.6,79.68,
PROTECTOR - UNIVERSAL HEEL-ELBOW VELFOAM,2600309,CDM,270,RC,,,outpatient,,,25,12.5,,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.6,38.4,,7.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.75,35,,7,percent of total billed charges,35% of total billed charges for outpatient setting,19.5,78,,15.6,percent of total billed charges,78% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,17.5,70,,14,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.75,75,,15,percent of total billed charges,75% of total billed charges for outpatient setting,20.75,83,,16.6,percent of total billed charges,83% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,12.5,50,,10,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.79,39.17,,7.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.75,20.75,
SYSTEM - CAPSURE PERMANENT FIXATION,2600312,CDM,270,RC,,,outpatient,,,1298,649,,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.3,35,,363.44,percent of total billed charges,35% of total billed charges for outpatient setting,1012.44,78,,809.952,percent of total billed charges,78% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,1077.34,83,,861.872,percent of total billed charges,83% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,508.4,39.17,,406.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,454.3,1077.34,
TUBE - CANNULA TRACH SZ 6,2600313,CDM,270,RC,,,outpatient,,,1298,649,,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.3,35,,363.44,percent of total billed charges,35% of total billed charges for outpatient setting,1012.44,78,,809.952,percent of total billed charges,78% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,1077.34,83,,861.872,percent of total billed charges,83% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,508.4,39.17,,406.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,454.3,1077.34,
TUBE - SZ 10 CANNULA TRACH DISP,2600314,CDM,270,RC,,,outpatient,,,1298,649,,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,498.43,38.4,,398.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.3,35,,363.44,percent of total billed charges,35% of total billed charges for outpatient setting,1012.44,78,,809.952,percent of total billed charges,78% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,908.6,70,,726.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,973.5,75,,778.8,percent of total billed charges,75% of total billed charges for outpatient setting,1077.34,83,,861.872,percent of total billed charges,83% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,649,50,,519.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,508.4,39.17,,406.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,454.3,1077.34,
TUBING - CO2 SAMPLING CANNULA 7  O2,2600320,CDM,270,RC,,,outpatient,,,462,231,,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177.41,38.4,,141.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.41,38.4,,141.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,75,,277.2,percent of total billed charges,75% of total billed charges for outpatient setting,346.5,75,,277.2,percent of total billed charges,75% of total billed charges for outpatient setting,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,75,,277.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.7,35,,129.36,percent of total billed charges,35% of total billed charges for outpatient setting,360.36,78,,288.288,percent of total billed charges,78% of total billed charges for outpatient setting,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,323.4,70,,258.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.5,75,,277.2,percent of total billed charges,75% of total billed charges for outpatient setting,383.46,83,,306.768,percent of total billed charges,83% of total billed charges for outpatient setting,231,50,,184.8,percent of total billed charges,50% of total billed charges for outpatient setting,231,50,,184.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.96,39.17,,144.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,161.7,383.46,
DRESSING - OPTICELL AG+GEL FIBER 4X5,2600321,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRESSING - 6X6 EXUDERM SATIN HYDROCOLL,2600322,CDM,270,RC,,,outpatient,,,9.39,4.7,,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.61,38.4,,2.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.61,38.4,,2.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,7.04,75,,5.632,percent of total billed charges,75% of total billed charges for outpatient setting,7.04,75,,5.632,percent of total billed charges,75% of total billed charges for outpatient setting,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,7.04,75,,5.632,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.29,35,,2.632,percent of total billed charges,35% of total billed charges for outpatient setting,7.32,78,,5.856,percent of total billed charges,78% of total billed charges for outpatient setting,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,6.57,70,,5.256,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.04,75,,5.632,percent of total billed charges,75% of total billed charges for outpatient setting,7.79,83,,6.232,percent of total billed charges,83% of total billed charges for outpatient setting,4.7,50,,3.76,percent of total billed charges,50% of total billed charges for outpatient setting,4.7,50,,3.76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.68,39.17,,2.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.29,7.79,
DRESSING - THERAHONEY HONEY 1.5OZ TB GEL,2600323,CDM,270,RC,,,outpatient,,,27.7,13.85,,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.64,38.4,,8.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.64,38.4,,8.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,20.78,75,,16.624,percent of total billed charges,75% of total billed charges for outpatient setting,20.78,75,,16.624,percent of total billed charges,75% of total billed charges for outpatient setting,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,20.78,75,,16.624,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.7,35,,7.76,percent of total billed charges,35% of total billed charges for outpatient setting,21.61,78,,17.288,percent of total billed charges,78% of total billed charges for outpatient setting,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,19.39,70,,15.512,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.78,75,,16.624,percent of total billed charges,75% of total billed charges for outpatient setting,22.99,83,,18.392,percent of total billed charges,83% of total billed charges for outpatient setting,13.85,50,,11.08,percent of total billed charges,50% of total billed charges for outpatient setting,13.85,50,,11.08,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,39.17,,8.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.7,22.99,
CONDOM CATH -  SILCONE SZ MD LF,2600324,CDM,270,RC,,,outpatient,,,2.85,1.43,,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.09,38.4,,0.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.09,38.4,,0.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2.14,75,,1.712,percent of total billed charges,75% of total billed charges for outpatient setting,2.14,75,,1.712,percent of total billed charges,75% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2.14,75,,1.712,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1,35,,0.8,percent of total billed charges,35% of total billed charges for outpatient setting,2.22,78,,1.776,percent of total billed charges,78% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.14,75,,1.712,percent of total billed charges,75% of total billed charges for outpatient setting,2.37,83,,1.896,percent of total billed charges,83% of total billed charges for outpatient setting,1.43,50,,1.144,percent of total billed charges,50% of total billed charges for outpatient setting,1.43,50,,1.144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.11,39.17,,0.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1,2.37,
SYSTEM - FEMALE PRIMAFIT EXT URINE MANAG,2600325,CDM,270,RC,,,outpatient,,,33.63,16.82,,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.91,38.4,,10.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.91,38.4,,10.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,25.22,75,,20.176,percent of total billed charges,75% of total billed charges for outpatient setting,25.22,75,,20.176,percent of total billed charges,75% of total billed charges for outpatient setting,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,25.22,75,,20.176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.77,35,,9.416,percent of total billed charges,35% of total billed charges for outpatient setting,26.23,78,,20.984,percent of total billed charges,78% of total billed charges for outpatient setting,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,23.54,70,,18.832,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.22,75,,20.176,percent of total billed charges,75% of total billed charges for outpatient setting,27.91,83,,22.328,percent of total billed charges,83% of total billed charges for outpatient setting,16.82,50,,13.456,percent of total billed charges,50% of total billed charges for outpatient setting,16.82,50,,13.456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.17,39.17,,10.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.77,27.91,
DEVICE - MALE PRIMOFIT EXT URINE MANAG,2600326,CDM,270,RC,,,outpatient,,,54.94,27.47,,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.1,38.4,,16.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.1,38.4,,16.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,41.21,75,,32.968,percent of total billed charges,75% of total billed charges for outpatient setting,41.21,75,,32.968,percent of total billed charges,75% of total billed charges for outpatient setting,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,41.21,75,,32.968,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.23,35,,15.384,percent of total billed charges,35% of total billed charges for outpatient setting,42.85,78,,34.28,percent of total billed charges,78% of total billed charges for outpatient setting,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,38.46,70,,30.768,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.21,75,,32.968,percent of total billed charges,75% of total billed charges for outpatient setting,45.6,83,,36.48,percent of total billed charges,83% of total billed charges for outpatient setting,27.47,50,,21.976,percent of total billed charges,50% of total billed charges for outpatient setting,27.47,50,,21.976,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.52,39.17,,17.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.23,45.6,
SLEEVE - KENDALL SCD EXPRESS LARGE KNEE,2600327,CDM,270,RC,,,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,71.38,
SLEEVE - KENDALL SCD EXPRESS XLARGE KNEE,2600328,CDM,270,RC,,,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,71.38,
SLEEVE - KENDALL SCD EXPRESS MEDIUM KNEE,2600329,CDM,270,RC,,,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,43,50,,34.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.1,71.38,
NEBULIZER - HUDSON RCI MICRO MIST,2600330,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CATH - 16FR STR THORACIC,2600331,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CATH - 28FR STR THORACIC,2600332,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
CATH - 40FR STR THORACIC,2600333,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
SET - MINILOC SAFETY INFUSION 20GA X .75,2600334,CDM,270,RC,,,outpatient,,,38.52,19.26,,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.79,38.4,,11.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.79,38.4,,11.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,28.89,75,,23.112,percent of total billed charges,75% of total billed charges for outpatient setting,28.89,75,,23.112,percent of total billed charges,75% of total billed charges for outpatient setting,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,28.89,75,,23.112,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.48,35,,10.784,percent of total billed charges,35% of total billed charges for outpatient setting,30.05,78,,24.04,percent of total billed charges,78% of total billed charges for outpatient setting,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,26.96,70,,21.568,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.89,75,,23.112,percent of total billed charges,75% of total billed charges for outpatient setting,31.97,83,,25.576,percent of total billed charges,83% of total billed charges for outpatient setting,19.26,50,,15.408,percent of total billed charges,50% of total billed charges for outpatient setting,19.26,50,,15.408,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.09,39.17,,12.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.48,31.97,
AXOGUARD NERVE CONNECTOR AGX 210,2600335,CDM,278,RC,C1762,HCPCS,both,,,4050,2025,,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1417.5,35,,1134,percent of total billed charges,35% of total billed charges for outpatient setting,3159,78,,2527.2,percent of total billed charges,78% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3037.5,75,,2430,percent of total billed charges,75% of total billed charges for outpatient setting,3361.5,83,,2689.2,percent of total billed charges,83% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1586.3,39.17,,1269.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1417.5,3361.5,
7X7 FLEXIBLE CANNULAS AR-6570F,2600336,CDM,278,RC,C1762,HCPCS,both,,,4050,2025,,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1417.5,35,,1134,percent of total billed charges,35% of total billed charges for outpatient setting,3159,78,,2527.2,percent of total billed charges,78% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3037.5,75,,2430,percent of total billed charges,75% of total billed charges for outpatient setting,3361.5,83,,2689.2,percent of total billed charges,83% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1586.3,39.17,,1269.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1417.5,3361.5,
HD SCORPION NEEDLE,2600337,CDM,278,RC,C1762,HCPCS,both,,,4050,2025,,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1417.5,35,,1134,percent of total billed charges,35% of total billed charges for outpatient setting,3159,78,,2527.2,percent of total billed charges,78% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3037.5,75,,2430,percent of total billed charges,75% of total billed charges for outpatient setting,3361.5,83,,2689.2,percent of total billed charges,83% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1586.3,39.17,,1269.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1417.5,3361.5,
KIT - TRIMANO BEACH CHAIR,2600338,CDM,278,RC,C1762,HCPCS,both,,,4050,2025,,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1555.2,38.4,,1244.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,2835,70,,2268,percent of total billed charges,70% of billed charges for implant carveouts,3240,80,,2592,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1417.5,35,,1134,percent of total billed charges,35% of total billed charges for outpatient setting,3159,78,,2527.2,percent of total billed charges,78% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,2835,70,,2268,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3037.5,75,,2430,percent of total billed charges,75% of total billed charges for outpatient setting,3361.5,83,,2689.2,percent of total billed charges,83% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,2025,50,,1620,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1586.3,39.17,,1269.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1417.5,3361.5,
MASK - POM # 1001-MM,2600339,CDM,278,RC,C1762,HCPCS,both,,,660,330,,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,253.44,38.4,,202.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,253.44,38.4,,202.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,462,70,,369.6,percent of total billed charges,70% of billed charges for implant carveouts,462,70,,369.6,percent of total billed charges,70% of billed charges for implant carveouts,462,70,,369.6,percent of total billed charges,70% of billed charges for implant carveouts,528,80,,422.4,percent of total billed charges,80% of billed charges for implant carveouts,528,80,,422.4,percent of total billed charges,80% of billed charges for implant carveouts,462,70,,369.6,percent of total billed charges,70% of billed charges for implant carveouts,528,80,,422.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231,35,,184.8,percent of total billed charges,35% of total billed charges for outpatient setting,514.8,78,,411.84,percent of total billed charges,78% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,462,70,,369.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,495,75,,396,percent of total billed charges,75% of total billed charges for outpatient setting,547.8,83,,438.24,percent of total billed charges,83% of total billed charges for outpatient setting,330,50,,264,percent of total billed charges,50% of total billed charges for outpatient setting,330,50,,264,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.51,39.17,,206.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,231,547.8,
SPECTRUM LOPRO S4 STERILE,2600340,CDM,278,RC,C1762,HCPCS,both,,,1140,570,,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,437.76,38.4,,350.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,437.76,38.4,,350.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,798,70,,638.4,percent of total billed charges,70% of billed charges for implant carveouts,798,70,,638.4,percent of total billed charges,70% of billed charges for implant carveouts,798,70,,638.4,percent of total billed charges,70% of billed charges for implant carveouts,912,80,,729.6,percent of total billed charges,80% of billed charges for implant carveouts,912,80,,729.6,percent of total billed charges,80% of billed charges for implant carveouts,798,70,,638.4,percent of total billed charges,70% of billed charges for implant carveouts,912,80,,729.6,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,399,35,,319.2,percent of total billed charges,35% of total billed charges for outpatient setting,889.2,78,,711.36,percent of total billed charges,78% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,855,75,,684,percent of total billed charges,75% of total billed charges for outpatient setting,946.2,83,,756.96,percent of total billed charges,83% of total billed charges for outpatient setting,570,50,,456,percent of total billed charges,50% of total billed charges for outpatient setting,570,50,,456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,446.52,39.17,,357.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,399,946.2,
SUTURE - VCP311H 3-0 VICRYL,2600346,CDM,274,RC,A9270,HCPCS,both,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,351,70,,280.8,percent of total billed charges,70% of total billed charges for outpatient setting,351,70,,280.8,percent of total billed charges,70% of total billed charges for outpatient setting,351,70,,280.8,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,351,70,,280.8,percent of total billed charges,70% of total billed charges for outpatient setting,351,75,,280.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,351,
SPECTRUM LOPRO S3 STERILE,2600352,CDM,270,RC,,,outpatient,,,1140,570,,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,437.76,38.4,,350.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,437.76,38.4,,350.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,855,75,,684,percent of total billed charges,75% of total billed charges for outpatient setting,855,75,,684,percent of total billed charges,75% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,855,75,,684,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,399,35,,319.2,percent of total billed charges,35% of total billed charges for outpatient setting,889.2,78,,711.36,percent of total billed charges,78% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,798,70,,638.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,855,75,,684,percent of total billed charges,75% of total billed charges for outpatient setting,946.2,83,,756.96,percent of total billed charges,83% of total billed charges for outpatient setting,570,50,,456,percent of total billed charges,50% of total billed charges for outpatient setting,570,50,,456,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,446.52,39.17,,357.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,399,946.2,
WIRE - 1.3 GUIDE  80-2039,2600353,CDM,270,RC,C1713,HCPCS,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
DRILL - 2.7 CANNULATED   80-2075,2600354,CDM,270,RC,C1713,HCPCS,outpatient,,,2360,1180,,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,906.24,38.4,,724.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,906.24,38.4,,724.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,826,35,,660.8,percent of total billed charges,35% of total billed charges for outpatient setting,1840.8,78,,1472.64,percent of total billed charges,78% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,1652,70,,1321.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1770,75,,1416,percent of total billed charges,75% of total billed charges for outpatient setting,1958.8,83,,1567.04,percent of total billed charges,83% of total billed charges for outpatient setting,1180,50,,944,percent of total billed charges,50% of total billed charges for outpatient setting,1180,50,,944,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,924.36,39.17,,739.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,826,1958.8,
SCREW - 42 MM X 4.0 CANNULATED,2600355,CDM,270,RC,C1713,HCPCS,outpatient,,,1045,522.5,,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,401.28,38.4,,321.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,401.28,38.4,,321.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.75,35,,292.6,percent of total billed charges,35% of total billed charges for outpatient setting,815.1,78,,652.08,percent of total billed charges,78% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,731.5,70,,585.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,783.75,75,,627,percent of total billed charges,75% of total billed charges for outpatient setting,867.35,83,,693.88,percent of total billed charges,83% of total billed charges for outpatient setting,522.5,50,,418,percent of total billed charges,50% of total billed charges for outpatient setting,522.5,50,,418,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,409.31,39.17,,327.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,365.75,867.35,
TATTOO - SPOT EX,2600357,CDM,270,RC,,,outpatient,,,245,122.5,,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.08,38.4,,75.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.08,38.4,,75.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.75,35,,68.6,percent of total billed charges,35% of total billed charges for outpatient setting,191.1,78,,152.88,percent of total billed charges,78% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.5,70,,137.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.75,75,,147,percent of total billed charges,75% of total billed charges for outpatient setting,203.35,83,,162.68,percent of total billed charges,83% of total billed charges for outpatient setting,122.5,50,,98,percent of total billed charges,50% of total billed charges for outpatient setting,122.5,50,,98,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.96,39.17,,76.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.75,203.35,
NEEDLE - 22GA X 2 STIMUPLEX,2600358,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
SUTURETAPE AR-7506,2600359,CDM,270,RC,C1713,HCPCS,outpatient,,,350,175,,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.5,35,,98,percent of total billed charges,35% of total billed charges for outpatient setting,273,78,,218.4,percent of total billed charges,78% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,290.5,83,,232.4,percent of total billed charges,83% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.09,39.17,,109.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.5,290.5,
3X8 DISPOSABLE KIT  AR-1530DS,2600360,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
TENODEMIS SCREW BIOCOMPOSITE W INSERTER,2600361,CDM,270,RC,C1713,HCPCS,outpatient,,,2835,1417.5,,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1088.64,38.4,,870.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1088.64,38.4,,870.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,2126.25,75,,1701,percent of total billed charges,75% of total billed charges for outpatient setting,2126.25,75,,1701,percent of total billed charges,75% of total billed charges for outpatient setting,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,2126.25,75,,1701,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,992.25,35,,793.8,percent of total billed charges,35% of total billed charges for outpatient setting,2211.3,78,,1769.04,percent of total billed charges,78% of total billed charges for outpatient setting,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,1984.5,70,,1587.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2126.25,75,,1701,percent of total billed charges,75% of total billed charges for outpatient setting,2353.05,83,,1882.44,percent of total billed charges,83% of total billed charges for outpatient setting,1417.5,50,,1134,percent of total billed charges,50% of total billed charges for outpatient setting,1417.5,50,,1134,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1110.41,39.17,,888.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,992.25,2353.05,
IMPLANT SYSTEM - ACHILLES MIDSUBSTANCE S,2600362,CDM,270,RC,C1713,HCPCS,outpatient,,,4485,2242.5,,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1569.75,35,,1255.8,percent of total billed charges,35% of total billed charges for outpatient setting,3498.3,78,,2798.64,percent of total billed charges,78% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3722.55,83,,2978.04,percent of total billed charges,83% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.68,39.17,,1405.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1569.75,3722.55,
SCREW - 2.7 X 14 MM  LOCKING,2600366,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW - 2.7 X 12 MM  LOCKING,2600367,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW - 3.5 X 14 MM  LOCKING,2600368,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW - 3.5 X 16 MM  LOCKING,2600369,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SYSTEM - ANKLE SYNDESMOSIS REPAIR,2600370,CDM,270,RC,C1713,HCPCS,outpatient,,,10200,5100,,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3916.8,38.4,,3133.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3916.8,38.4,,3133.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3570,35,,2856,percent of total billed charges,35% of total billed charges for outpatient setting,7956,78,,6364.8,percent of total billed charges,78% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,7140,70,,5712,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7650,75,,6120,percent of total billed charges,75% of total billed charges for outpatient setting,8466,83,,6772.8,percent of total billed charges,83% of total billed charges for outpatient setting,5100,50,,4080,percent of total billed charges,50% of total billed charges for outpatient setting,5100,50,,4080,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3995.14,39.17,,3196.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3570,8466,
DRILL BIT - 2.0   80-2378,2600371,CDM,270,RC,C1713,HCPCS,outpatient,,,1165,582.5,,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,407.75,35,,326.2,percent of total billed charges,35% of total billed charges for outpatient setting,908.7,78,,726.96,percent of total billed charges,78% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,966.95,83,,773.56,percent of total billed charges,83% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.31,39.17,,365.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,407.75,966.95,
DRILL BIT - 2.8   80-2379,2600372,CDM,270,RC,C1713,HCPCS,outpatient,,,1165,582.5,,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,447.36,38.4,,357.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,407.75,35,,326.2,percent of total billed charges,35% of total billed charges for outpatient setting,908.7,78,,726.96,percent of total billed charges,78% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,815.5,70,,652.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,873.75,75,,699,percent of total billed charges,75% of total billed charges for outpatient setting,966.95,83,,773.56,percent of total billed charges,83% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,582.5,50,,466,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.31,39.17,,365.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,407.75,966.95,
FIBERTAPE  2MM,2600373,CDM,270,RC,C1713,HCPCS,outpatient,,,2275,1137.5,,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,873.6,38.4,,698.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,873.6,38.4,,698.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,1706.25,75,,1365,percent of total billed charges,75% of total billed charges for outpatient setting,1706.25,75,,1365,percent of total billed charges,75% of total billed charges for outpatient setting,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,1706.25,75,,1365,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,796.25,35,,637,percent of total billed charges,35% of total billed charges for outpatient setting,1774.5,78,,1419.6,percent of total billed charges,78% of total billed charges for outpatient setting,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,1592.5,70,,1274,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1706.25,75,,1365,percent of total billed charges,75% of total billed charges for outpatient setting,1888.25,83,,1510.6,percent of total billed charges,83% of total billed charges for outpatient setting,1137.5,50,,910,percent of total billed charges,50% of total billed charges for outpatient setting,1137.5,50,,910,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,891.07,39.17,,712.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,796.25,1888.25,
FIBERTAPE   CARCIAGE  2MM 48,2600374,CDM,270,RC,C1713,HCPCS,outpatient,,,3825,1912.5,,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1468.8,38.4,,1175.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1468.8,38.4,,1175.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,2868.75,75,,2295,percent of total billed charges,75% of total billed charges for outpatient setting,2868.75,75,,2295,percent of total billed charges,75% of total billed charges for outpatient setting,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,2868.75,75,,2295,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1338.75,35,,1071,percent of total billed charges,35% of total billed charges for outpatient setting,2983.5,78,,2386.8,percent of total billed charges,78% of total billed charges for outpatient setting,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,2677.5,70,,2142,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2868.75,75,,2295,percent of total billed charges,75% of total billed charges for outpatient setting,3174.75,83,,2539.8,percent of total billed charges,83% of total billed charges for outpatient setting,1912.5,50,,1530,percent of total billed charges,50% of total billed charges for outpatient setting,1912.5,50,,1530,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1498.18,39.17,,1198.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1338.75,3174.75,
FIBERTAPE   DISPOSABLE  TENSIONEN,2600375,CDM,270,RC,C1713,HCPCS,outpatient,,,1377,688.5,,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.77,38.4,,423.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.77,38.4,,423.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges for outpatient setting,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,481.95,35,,385.56,percent of total billed charges,35% of total billed charges for outpatient setting,1074.06,78,,859.248,percent of total billed charges,78% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges for outpatient setting,1142.91,83,,914.328,percent of total billed charges,83% of total billed charges for outpatient setting,688.5,50,,550.8,percent of total billed charges,50% of total billed charges for outpatient setting,688.5,50,,550.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.35,39.17,,431.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,481.95,1142.91,
1.6 K-WIRE  AR-5050K-1,2600376,CDM,270,RC,C1713,HCPCS,outpatient,,,470,235,,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.48,38.4,,144.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.48,38.4,,144.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,352.5,75,,282,percent of total billed charges,75% of total billed charges for outpatient setting,352.5,75,,282,percent of total billed charges,75% of total billed charges for outpatient setting,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,352.5,75,,282,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.5,35,,131.6,percent of total billed charges,35% of total billed charges for outpatient setting,366.6,78,,293.28,percent of total billed charges,78% of total billed charges for outpatient setting,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,329,70,,263.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,352.5,75,,282,percent of total billed charges,75% of total billed charges for outpatient setting,390.1,83,,312.08,percent of total billed charges,83% of total billed charges for outpatient setting,235,50,,188,percent of total billed charges,50% of total billed charges for outpatient setting,235,50,,188,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.09,39.17,,147.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,164.5,390.1,
MASK - ANESTHESIA W/ TAIL VALVE ADULTSZ5,2600379,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
TENSIONER - DISPOSABLE CERCLAGE,2600383,CDM,270,RC,A7030,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,74.7,
3.5MM SELF-PUNCHING PUSHLOCK ANCHOR,2600384,CDM,270,RC,A7030,HCPCS,outpatient,,,2250,1125,,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1755,78,,1404,percent of total billed charges,78% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1867.5,83,,1494,percent of total billed charges,83% of total billed charges for outpatient setting,1125,50,,900,percent of total billed charges,50% of total billed charges for outpatient setting,1125,50,,900,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1125,1867.5,
BIOCOMPOSITE KNOTLESS SWIVELW/ANCHOR,2600385,CDM,270,RC,C1713,HCPCS,outpatient,,,2301,1150.5,,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,805.35,35,,644.28,percent of total billed charges,35% of total billed charges for outpatient setting,1794.78,78,,1435.824,percent of total billed charges,78% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1909.83,83,,1527.864,percent of total billed charges,83% of total billed charges for outpatient setting,1150.5,50,,920.4,percent of total billed charges,50% of total billed charges for outpatient setting,1150.5,50,,920.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,901.25,39.17,,721,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,805.35,1909.83,
BIOCOMPOSITE KNTLSS SWIVELLOCK 4.75X19.1,2600386,CDM,270,RC,C1713,HCPCS,outpatient,,,2301,1150.5,,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,805.35,35,,644.28,percent of total billed charges,35% of total billed charges for outpatient setting,1794.78,78,,1435.824,percent of total billed charges,78% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1909.83,83,,1527.864,percent of total billed charges,83% of total billed charges for outpatient setting,1150.5,50,,920.4,percent of total billed charges,50% of total billed charges for outpatient setting,1150.5,50,,920.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,901.25,39.17,,721,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,805.35,1909.83,
IMPLANT SYSTEM PARS SUTURETAPE,2600387,CDM,270,RC,C1713,HCPCS,outpatient,,,7840,3920,,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3010.56,38.4,,2408.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3010.56,38.4,,2408.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,5880,75,,4704,percent of total billed charges,75% of total billed charges for outpatient setting,5880,75,,4704,percent of total billed charges,75% of total billed charges for outpatient setting,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,5880,75,,4704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2744,35,,2195.2,percent of total billed charges,35% of total billed charges for outpatient setting,6115.2,78,,4892.16,percent of total billed charges,78% of total billed charges for outpatient setting,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,5488,70,,4390.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5880,75,,4704,percent of total billed charges,75% of total billed charges for outpatient setting,6507.2,83,,5205.76,percent of total billed charges,83% of total billed charges for outpatient setting,3920,50,,3136,percent of total billed charges,50% of total billed charges for outpatient setting,3920,50,,3136,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3070.77,39.17,,2456.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2744,6507.2,
IMPLANT SYSTEM ACHILLES MIDSUBST SPEEDBR,2600388,CDM,270,RC,C1713,HCPCS,outpatient,,,17420,8710,,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6689.28,38.4,,5351.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6689.28,38.4,,5351.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,13065,75,,10452,percent of total billed charges,75% of total billed charges for outpatient setting,13065,75,,10452,percent of total billed charges,75% of total billed charges for outpatient setting,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,13065,75,,10452,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6097,35,,4877.6,percent of total billed charges,35% of total billed charges for outpatient setting,13587.6,78,,10870.08,percent of total billed charges,78% of total billed charges for outpatient setting,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,12194,70,,9755.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13065,75,,10452,percent of total billed charges,75% of total billed charges for outpatient setting,14458.6,83,,11566.88,percent of total billed charges,83% of total billed charges for outpatient setting,8710,50,,6968,percent of total billed charges,50% of total billed charges for outpatient setting,8710,50,,6968,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6823.07,39.17,,5458.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6097,14458.6,
3.5MM SELF-PUNCHING PUSHLOCK ANCHOR,2600389,CDM,270,RC,C1713,HCPCS,outpatient,,,2250,1125,,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,864,38.4,,691.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,864,38.4,,691.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,787.5,35,,630,percent of total billed charges,35% of total billed charges for outpatient setting,1755,78,,1404,percent of total billed charges,78% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,1575,70,,1260,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1687.5,75,,1350,percent of total billed charges,75% of total billed charges for outpatient setting,1867.5,83,,1494,percent of total billed charges,83% of total billed charges for outpatient setting,1125,50,,900,percent of total billed charges,50% of total billed charges for outpatient setting,1125,50,,900,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,881.28,39.17,,705.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,787.5,1867.5,
SUTURE ANCHOR BIOCOMPOSITE SWIVELLOCK,2600390,CDM,270,RC,C1713,HCPCS,outpatient,,,2001,1000.5,,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,768.38,38.4,,614.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,768.38,38.4,,614.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,700.35,35,,560.28,percent of total billed charges,35% of total billed charges for outpatient setting,1560.78,78,,1248.624,percent of total billed charges,78% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1660.83,83,,1328.664,percent of total billed charges,83% of total billed charges for outpatient setting,1000.5,50,,800.4,percent of total billed charges,50% of total billed charges for outpatient setting,1000.5,50,,800.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,783.75,39.17,,627,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,700.35,1660.83,
SUTURE ANCHOR BIO-COMPOSITE PUSHLOCK,2600391,CDM,270,RC,C1713,HCPCS,outpatient,,,2001,1000.5,,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,768.38,38.4,,614.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,768.38,38.4,,614.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,700.35,35,,560.28,percent of total billed charges,35% of total billed charges for outpatient setting,1560.78,78,,1248.624,percent of total billed charges,78% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,1400.7,70,,1120.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1500.75,75,,1200.6,percent of total billed charges,75% of total billed charges for outpatient setting,1660.83,83,,1328.664,percent of total billed charges,83% of total billed charges for outpatient setting,1000.5,50,,800.4,percent of total billed charges,50% of total billed charges for outpatient setting,1000.5,50,,800.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,783.75,39.17,,627,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,700.35,1660.83,
LOOP N TAPE 4.75 SWIVELOCK,2600392,CDM,270,RC,C1713,HCPCS,outpatient,,,4002,2001,,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1536.77,38.4,,1229.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1536.77,38.4,,1229.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,3001.5,75,,2401.2,percent of total billed charges,75% of total billed charges for outpatient setting,3001.5,75,,2401.2,percent of total billed charges,75% of total billed charges for outpatient setting,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,3001.5,75,,2401.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1400.7,35,,1120.56,percent of total billed charges,35% of total billed charges for outpatient setting,3121.56,78,,2497.248,percent of total billed charges,78% of total billed charges for outpatient setting,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,2801.4,70,,2241.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3001.5,75,,2401.2,percent of total billed charges,75% of total billed charges for outpatient setting,3321.66,83,,2657.328,percent of total billed charges,83% of total billed charges for outpatient setting,2001,50,,1600.8,percent of total billed charges,50% of total billed charges for outpatient setting,2001,50,,1600.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1567.51,39.17,,1254.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1400.7,3321.66,
FIBERLINK - AR-7535,2600393,CDM,270,RC,C1713,HCPCS,outpatient,,,426,213,,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.58,38.4,,130.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.58,38.4,,130.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.1,35,,119.28,percent of total billed charges,35% of total billed charges for outpatient setting,332.28,78,,265.824,percent of total billed charges,78% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.58,83,,282.864,percent of total billed charges,83% of total billed charges for outpatient setting,213,50,,170.4,percent of total billed charges,50% of total billed charges for outpatient setting,213,50,,170.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.85,39.17,,133.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,149.1,353.58,
SUREFIRE SCORPION NEEDLE AR-1399IN,2600394,CDM,270,RC,C1713,HCPCS,outpatient,,,702,351,,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.57,38.4,,215.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,269.57,38.4,,215.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,526.5,75,,421.2,percent of total billed charges,75% of total billed charges for outpatient setting,526.5,75,,421.2,percent of total billed charges,75% of total billed charges for outpatient setting,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,526.5,75,,421.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.7,35,,196.56,percent of total billed charges,35% of total billed charges for outpatient setting,547.56,78,,438.048,percent of total billed charges,78% of total billed charges for outpatient setting,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,491.4,70,,393.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,526.5,75,,421.2,percent of total billed charges,75% of total billed charges for outpatient setting,582.66,83,,466.128,percent of total billed charges,83% of total billed charges for outpatient setting,351,50,,280.8,percent of total billed charges,50% of total billed charges for outpatient setting,351,50,,280.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.96,39.17,,219.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,245.7,582.66,
FIBERTAPE - AR-7237-7,2600395,CDM,270,RC,C1713,HCPCS,outpatient,,,249,124.5,,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.62,38.4,,76.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,95.62,38.4,,76.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,186.75,75,,149.4,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,75,,149.4,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,186.75,75,,149.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.15,35,,69.72,percent of total billed charges,35% of total billed charges for outpatient setting,194.22,78,,155.376,percent of total billed charges,78% of total billed charges for outpatient setting,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,174.3,70,,139.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,186.75,75,,149.4,percent of total billed charges,75% of total billed charges for outpatient setting,206.67,83,,165.336,percent of total billed charges,83% of total billed charges for outpatient setting,124.5,50,,99.6,percent of total billed charges,50% of total billed charges for outpatient setting,124.5,50,,99.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.53,39.17,,78.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.15,206.67,
PLATE - 7 HOLE 1/3RD 7008-0107,2600396,CDM,270,RC,C1713,HCPCS,outpatient,,,780,390,,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.52,38.4,,239.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,299.52,38.4,,239.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,273,35,,218.4,percent of total billed charges,35% of total billed charges for outpatient setting,608.4,78,,486.72,percent of total billed charges,78% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,546,70,,436.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,585,75,,468,percent of total billed charges,75% of total billed charges for outpatient setting,647.4,83,,517.92,percent of total billed charges,83% of total billed charges for outpatient setting,390,50,,312,percent of total billed charges,50% of total billed charges for outpatient setting,390,50,,312,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,305.51,39.17,,244.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,273,647.4,
SCREW - 3.5 X 12 NON-LOCKING 30-0257,2600397,CDM,270,RC,C1713,HCPCS,outpatient,,,580,290,,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,222.72,38.4,,178.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,222.72,38.4,,178.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,203,35,,162.4,percent of total billed charges,35% of total billed charges for outpatient setting,452.4,78,,361.92,percent of total billed charges,78% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,481.4,83,,385.12,percent of total billed charges,83% of total billed charges for outpatient setting,290,50,,232,percent of total billed charges,50% of total billed charges for outpatient setting,290,50,,232,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,227.17,39.17,,181.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,203,481.4,
SCREW - 3.5 X 10 NON-LOCKING 30-0256,2600398,CDM,270,RC,C1713,HCPCS,outpatient,,,580,290,,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,222.72,38.4,,178.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,222.72,38.4,,178.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,203,35,,162.4,percent of total billed charges,35% of total billed charges for outpatient setting,452.4,78,,361.92,percent of total billed charges,78% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,406,70,,324.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,435,75,,348,percent of total billed charges,75% of total billed charges for outpatient setting,481.4,83,,385.12,percent of total billed charges,83% of total billed charges for outpatient setting,290,50,,232,percent of total billed charges,50% of total billed charges for outpatient setting,290,50,,232,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,227.17,39.17,,181.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,203,481.4,
SYSTEM - ANKLE SYNDEMOSIS REPAIR,2600399,CDM,270,RC,C1713,HCPCS,outpatient,,,4371,2185.5,,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1678.46,38.4,,1342.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1678.46,38.4,,1342.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1529.85,35,,1223.88,percent of total billed charges,35% of total billed charges for outpatient setting,3409.38,78,,2727.504,percent of total billed charges,78% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,3059.7,70,,2447.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3278.25,75,,2622.6,percent of total billed charges,75% of total billed charges for outpatient setting,3627.93,83,,2902.344,percent of total billed charges,83% of total billed charges for outpatient setting,2185.5,50,,1748.4,percent of total billed charges,50% of total billed charges for outpatient setting,2185.5,50,,1748.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1712.03,39.17,,1369.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1529.85,3627.93,
4.0 X 48 LONG THREAD 3006-40048,2600400,CDM,270,RC,C1713,HCPCS,outpatient,,,1445,722.5,,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,554.88,38.4,,443.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,554.88,38.4,,443.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,1083.75,75,,867,percent of total billed charges,75% of total billed charges for outpatient setting,1083.75,75,,867,percent of total billed charges,75% of total billed charges for outpatient setting,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,1083.75,75,,867,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,505.75,35,,404.6,percent of total billed charges,35% of total billed charges for outpatient setting,1127.1,78,,901.68,percent of total billed charges,78% of total billed charges for outpatient setting,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,1011.5,70,,809.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1083.75,75,,867,percent of total billed charges,75% of total billed charges for outpatient setting,1199.35,83,,959.48,percent of total billed charges,83% of total billed charges for outpatient setting,722.5,50,,578,percent of total billed charges,50% of total billed charges for outpatient setting,722.5,50,,578,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,565.98,39.17,,452.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,505.75,1199.35,
DRILL BIT - 3.5  80-2503,2600401,CDM,270,RC,C1713,HCPCS,outpatient,,,1190,595,,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.96,38.4,,365.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,456.96,38.4,,365.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.5,35,,333.2,percent of total billed charges,35% of total billed charges for outpatient setting,928.2,78,,742.56,percent of total billed charges,78% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,987.7,83,,790.16,percent of total billed charges,83% of total billed charges for outpatient setting,595,50,,476,percent of total billed charges,50% of total billed charges for outpatient setting,595,50,,476,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.1,39.17,,372.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.5,987.7,
PLATE - 8 HOLE 1/3RD 7008-0108,2600402,CDM,270,RC,C1713,HCPCS,outpatient,,,777,388.5,,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,298.37,38.4,,238.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,298.37,38.4,,238.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,582.75,75,,466.2,percent of total billed charges,75% of total billed charges for outpatient setting,582.75,75,,466.2,percent of total billed charges,75% of total billed charges for outpatient setting,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,582.75,75,,466.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,271.95,35,,217.56,percent of total billed charges,35% of total billed charges for outpatient setting,606.06,78,,484.848,percent of total billed charges,78% of total billed charges for outpatient setting,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,543.9,70,,435.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,582.75,75,,466.2,percent of total billed charges,75% of total billed charges for outpatient setting,644.91,83,,515.928,percent of total billed charges,83% of total billed charges for outpatient setting,388.5,50,,310.8,percent of total billed charges,50% of total billed charges for outpatient setting,388.5,50,,310.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,304.34,39.17,,243.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,271.95,644.91,
SCREW - 4.0 X 10MM CANCELLOUS,2600403,CDM,270,RC,C1713,HCPCS,outpatient,,,560,280,,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.04,38.4,,172.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,215.04,38.4,,172.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,420,75,,336,percent of total billed charges,75% of total billed charges for outpatient setting,420,75,,336,percent of total billed charges,75% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,420,75,,336,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196,35,,156.8,percent of total billed charges,35% of total billed charges for outpatient setting,436.8,78,,349.44,percent of total billed charges,78% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,420,75,,336,percent of total billed charges,75% of total billed charges for outpatient setting,464.8,83,,371.84,percent of total billed charges,83% of total billed charges for outpatient setting,280,50,,224,percent of total billed charges,50% of total billed charges for outpatient setting,280,50,,224,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,219.34,39.17,,175.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,196,464.8,
DVR CROSS LOCK NARROW PLATE LEFT,2600404,CDM,270,RC,C1713,HCPCS,outpatient,,,5590,2795,,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1956.5,35,,1565.2,percent of total billed charges,35% of total billed charges for outpatient setting,4360.2,78,,3488.16,percent of total billed charges,78% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,4639.7,83,,3711.76,percent of total billed charges,83% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2189.49,39.17,,1751.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1956.5,4639.7,
LOW PROFILE NON-LOCK SCREW 2.7MMX14MM,2600405,CDM,270,RC,C1713,HCPCS,outpatient,,,445,222.5,,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.75,35,,124.6,percent of total billed charges,35% of total billed charges for outpatient setting,347.1,78,,277.68,percent of total billed charges,78% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,369.35,83,,295.48,percent of total billed charges,83% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.3,39.17,,139.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,155.75,369.35,
LOCKING SCREW 2.7MMX14MM,2600406,CDM,270,RC,C1713,HCPCS,outpatient,,,705,352.5,,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.75,35,,197.4,percent of total billed charges,35% of total billed charges for outpatient setting,549.9,78,,439.92,percent of total billed charges,78% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,585.15,83,,468.12,percent of total billed charges,83% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.13,39.17,,220.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.75,585.15,
LOCKING SCREW 2.7MMX18MM,2600407,CDM,270,RC,C1713,HCPCS,outpatient,,,705,352.5,,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.75,35,,197.4,percent of total billed charges,35% of total billed charges for outpatient setting,549.9,78,,439.92,percent of total billed charges,78% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,585.15,83,,468.12,percent of total billed charges,83% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.13,39.17,,220.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.75,585.15,
LOCKING SCREW 2.7MM X 20MM,2600408,CDM,270,RC,C1713,HCPCS,outpatient,,,5590,2795,,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2146.56,38.4,,1717.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1956.5,35,,1565.2,percent of total billed charges,35% of total billed charges for outpatient setting,4360.2,78,,3488.16,percent of total billed charges,78% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,3913,70,,3130.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4192.5,75,,3354,percent of total billed charges,75% of total billed charges for outpatient setting,4639.7,83,,3711.76,percent of total billed charges,83% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,2795,50,,2236,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2189.49,39.17,,1751.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1956.5,4639.7,
DRILL BIT 2.2MM NS,2600409,CDM,270,RC,C1713,HCPCS,outpatient,,,590,295,,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,226.56,38.4,,181.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,226.56,38.4,,181.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,442.5,75,,354,percent of total billed charges,75% of total billed charges for outpatient setting,442.5,75,,354,percent of total billed charges,75% of total billed charges for outpatient setting,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,442.5,75,,354,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,206.5,35,,165.2,percent of total billed charges,35% of total billed charges for outpatient setting,460.2,78,,368.16,percent of total billed charges,78% of total billed charges for outpatient setting,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,413,70,,330.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,442.5,75,,354,percent of total billed charges,75% of total billed charges for outpatient setting,489.7,83,,391.76,percent of total billed charges,83% of total billed charges for outpatient setting,295,50,,236,percent of total billed charges,50% of total billed charges for outpatient setting,295,50,,236,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,231.09,39.17,,184.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,206.5,489.7,
LOW PROFILE NON-LOCK SCREW 2.7MMX12MM,2600410,CDM,270,RC,C1713,HCPCS,outpatient,,,445,222.5,,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.88,38.4,,136.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.75,35,,124.6,percent of total billed charges,35% of total billed charges for outpatient setting,347.1,78,,277.68,percent of total billed charges,78% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,311.5,70,,249.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.75,75,,267,percent of total billed charges,75% of total billed charges for outpatient setting,369.35,83,,295.48,percent of total billed charges,83% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,222.5,50,,178,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.3,39.17,,139.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,155.75,369.35,
LOCKING SCREW 2.7MMX16MM,2600411,CDM,270,RC,C1713,HCPCS,outpatient,,,705,352.5,,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.72,38.4,,216.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.75,35,,197.4,percent of total billed charges,35% of total billed charges for outpatient setting,549.9,78,,439.92,percent of total billed charges,78% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,493.5,70,,394.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.75,75,,423,percent of total billed charges,75% of total billed charges for outpatient setting,585.15,83,,468.12,percent of total billed charges,83% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,352.5,50,,282,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,276.13,39.17,,220.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.75,585.15,
DVR CROSS LOCK NARROW PLATE RIGHT,2600412,CDM,270,RC,C1713,HCPCS,outpatient,,,525,262.5,,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.75,35,,147,percent of total billed charges,35% of total billed charges for outpatient setting,409.5,78,,327.6,percent of total billed charges,78% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,435.75,83,,348.6,percent of total billed charges,83% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.63,39.17,,164.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,183.75,435.75,
SPONGE - STERILE X-RAY DETECT GAUZE 4X4,2600413,CDM,270,RC,C1713,HCPCS,outpatient,,,208,104,,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.87,38.4,,63.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.8,35,,58.24,percent of total billed charges,35% of total billed charges for outpatient setting,162.24,78,,129.792,percent of total billed charges,78% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,145.6,70,,116.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156,75,,124.8,percent of total billed charges,75% of total billed charges for outpatient setting,172.64,83,,138.112,percent of total billed charges,83% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,104,50,,83.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.47,39.17,,65.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.8,172.64,
K-WIRE -  AR 8943-01,2600414,CDM,270,RC,C1713,HCPCS,outpatient,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49,35,,39.2,percent of total billed charges,35% of total billed charges for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.84,39.17,,43.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49,116.2,
DRILL BIT - 1.7MM  AR-8916-14,2600415,CDM,270,RC,C1713,HCPCS,outpatient,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,192.5,456.5,
DRILL BIT - 2.5MM  AR-8916-06,2600416,CDM,270,RC,C1713,HCPCS,outpatient,,,475,237.5,,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.4,38.4,,145.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,182.4,38.4,,145.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.25,35,,133,percent of total billed charges,35% of total billed charges for outpatient setting,370.5,78,,296.4,percent of total billed charges,78% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,332.5,70,,266,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,356.25,75,,285,percent of total billed charges,75% of total billed charges for outpatient setting,394.25,83,,315.4,percent of total billed charges,83% of total billed charges for outpatient setting,237.5,50,,190,percent of total billed charges,50% of total billed charges for outpatient setting,237.5,50,,190,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,186.05,39.17,,148.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,166.25,394.25,
SCREW - 3.5 X 12 CORTICAL  AR-8735-12,2600417,CDM,270,RC,C1713,HCPCS,outpatient,,,420,210,,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,35,,117.6,percent of total billed charges,35% of total billed charges for outpatient setting,327.6,78,,262.08,percent of total billed charges,78% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,348.6,83,,278.88,percent of total billed charges,83% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.51,39.17,,131.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147,348.6,
SCREW - 3.5 X 13 CORTICAL  AR-8735-13,2600418,CDM,270,RC,C1713,HCPCS,outpatient,,,420,210,,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,35,,117.6,percent of total billed charges,35% of total billed charges for outpatient setting,327.6,78,,262.08,percent of total billed charges,78% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,348.6,83,,278.88,percent of total billed charges,83% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.51,39.17,,131.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147,348.6,
SCREW - 3.5 X 12  LOCKING  AR-8835CL-12,2600419,CDM,270,RC,C1713,HCPCS,outpatient,,,3445,1722.5,,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1322.88,38.4,,1058.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1322.88,38.4,,1058.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2583.75,75,,2067,percent of total billed charges,75% of total billed charges for outpatient setting,2583.75,75,,2067,percent of total billed charges,75% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2583.75,75,,2067,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1205.75,35,,964.6,percent of total billed charges,35% of total billed charges for outpatient setting,2687.1,78,,2149.68,percent of total billed charges,78% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,2411.5,70,,1929.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2583.75,75,,2067,percent of total billed charges,75% of total billed charges for outpatient setting,2859.35,83,,2287.48,percent of total billed charges,83% of total billed charges for outpatient setting,1722.5,50,,1378,percent of total billed charges,50% of total billed charges for outpatient setting,1722.5,50,,1378,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1349.34,39.17,,1079.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1205.75,2859.35,
SCREW - 2.4 X 16  LOCKING  AR-8724VCL-16,2600420,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW - 2.4 X 22  CORTICAL AR-8916CX24-2,2600421,CDM,270,RC,C1713,HCPCS,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
PLATE - 3  HOLE NARROW LEFT AR-8916VNL-0,2600422,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
SCREW - 2.4 X 16 CORTICAL AR-8916CX24-16,2600423,CDM,270,RC,C1713,HCPCS,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
SCREW - 2.4 X 18 CORTICAL AR-8916CX24-18,2600424,CDM,270,RC,C1713,HCPCS,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
FIBULOCK IMPLANT SYSTEM,2600425,CDM,270,RC,C1713,HCPCS,outpatient,,,2100,1050,,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,806.4,38.4,,645.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,735,35,,588,percent of total billed charges,35% of total billed charges for outpatient setting,1638,78,,1310.4,percent of total billed charges,78% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,1470,70,,1176,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1575,75,,1260,percent of total billed charges,75% of total billed charges for outpatient setting,1743,83,,1394.4,percent of total billed charges,83% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,1050,50,,840,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,822.53,39.17,,658.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,735,1743,
NAIL - ARTHREX FIBULOCK 3X100MM RT,2600426,CDM,270,RC,C1713,HCPCS,outpatient,,,8985,4492.5,,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3450.24,38.4,,2760.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3450.24,38.4,,2760.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,6738.75,75,,5391,percent of total billed charges,75% of total billed charges for outpatient setting,6738.75,75,,5391,percent of total billed charges,75% of total billed charges for outpatient setting,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,6738.75,75,,5391,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3144.75,35,,2515.8,percent of total billed charges,35% of total billed charges for outpatient setting,7008.3,78,,5606.64,percent of total billed charges,78% of total billed charges for outpatient setting,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,6289.5,70,,5031.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6738.75,75,,5391,percent of total billed charges,75% of total billed charges for outpatient setting,7457.55,83,,5966.04,percent of total billed charges,83% of total billed charges for outpatient setting,4492.5,50,,3594,percent of total billed charges,50% of total billed charges for outpatient setting,4492.5,50,,3594,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3519.24,39.17,,2815.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3144.75,7457.55,
REAMER - LONG 3.2MM  AR-8973-32LS,2600427,CDM,270,RC,C1713,HCPCS,outpatient,,,450,225,,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.8,38.4,,138.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,172.8,38.4,,138.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.5,35,,126,percent of total billed charges,35% of total billed charges for outpatient setting,351,78,,280.8,percent of total billed charges,78% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,373.5,83,,298.8,percent of total billed charges,83% of total billed charges for outpatient setting,225,50,,180,percent of total billed charges,50% of total billed charges for outpatient setting,225,50,,180,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,176.26,39.17,,141.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,157.5,373.5,
SCREW - CANCELLOUS 3.0 X 14  AR-8830-14,2600428,CDM,270,RC,C1713,HCPCS,outpatient,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,87.15,
SCREW - CANCELLOUS 3.0 X 16  AR-8830-16,2600429,CDM,270,RC,C1713,HCPCS,outpatient,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,87.15,
SCREW -  2.7 X 14 CORTICAL   AR-8827-14,2600430,CDM,270,RC,C1713,HCPCS,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,35,,37.8,percent of total billed charges,35% of total billed charges for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.88,39.17,,42.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.25,112.05,
IMPLANT - SYNDESMOSIS TIGHTROPE XP,2600431,CDM,270,RC,C1713,HCPCS,outpatient,,,4485,2242.5,,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1722.24,38.4,,1377.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1569.75,35,,1255.8,percent of total billed charges,35% of total billed charges for outpatient setting,3498.3,78,,2798.64,percent of total billed charges,78% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,3139.5,70,,2511.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3363.75,75,,2691,percent of total billed charges,75% of total billed charges for outpatient setting,3722.55,83,,2978.04,percent of total billed charges,83% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,2242.5,50,,1794,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1756.68,39.17,,1405.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1569.75,3722.55,
PLATE - STANDARD 3 HOLE RIGHT,2600432,CDM,270,RC,C1713,HCPCS,outpatient,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW - 2.4 X18MM LOCKING,2600433,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW - 2.4 X20MM LOCKING,2600434,CDM,270,RC,C1713,HCPCS,outpatient,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 3.5 X 12MM CORTICAL,2600435,CDM,270,RC,C1713,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,149.4,
SCREW - 3.5 X 14MM CORTICAL,2600436,CDM,270,RC,C1713,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,149.4,
SCREW - 3.5 X 16MM CORTICAL,2600437,CDM,270,RC,C1713,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,149.4,
SCREW - 3.5 X 16MM LOCKING,2600438,CDM,270,RC,C1713,HCPCS,outpatient,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 3.5 X 14MM LOCKING  AR-8935CL-14,2600439,CDM,270,RC,C1713,HCPCS,outpatient,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 2.4 X 20MM CORTICAL,2600440,CDM,270,RC,C1713,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PLATE - 3 HOLE LEFT STANDARD  ARTHREX,2600441,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
PLATE - 3  HOLE NARROW RIGHT,2600442,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
PLATE - 3-HOLE STANDARD RIGHT,2600443,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
PLATE - 3-HOLE WIDE LEFT  AR-8916VWL-03,2600444,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
PLATE - 3-HOLE WIDE RIGHT  AR-8916VWR-03,2600445,CDM,270,RC,C1713,HCPCS,outpatient,,,5565,2782.5,,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2136.96,38.4,,1709.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1947.75,35,,1558.2,percent of total billed charges,35% of total billed charges for outpatient setting,4340.7,78,,3472.56,percent of total billed charges,78% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,3895.5,70,,3116.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4173.75,75,,3339,percent of total billed charges,75% of total billed charges for outpatient setting,4618.95,83,,3695.16,percent of total billed charges,83% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,2782.5,50,,2226,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2179.7,39.17,,1743.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1947.75,4618.95,
SCREW - 3.5 X 10MM CORTICAL AR-8935-10,2600446,CDM,270,RC,C1713,HCPCS,outpatient,,,420,210,,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,35,,117.6,percent of total billed charges,35% of total billed charges for outpatient setting,327.6,78,,262.08,percent of total billed charges,78% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,348.6,83,,278.88,percent of total billed charges,83% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.51,39.17,,131.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147,348.6,
SCREW - 3.5 X 12MM CORTICAL AR-8935-12,2600447,CDM,270,RC,C1713,HCPCS,outpatient,,,420,210,,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,35,,117.6,percent of total billed charges,35% of total billed charges for outpatient setting,327.6,78,,262.08,percent of total billed charges,78% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,348.6,83,,278.88,percent of total billed charges,83% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.51,39.17,,131.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147,348.6,
SCREW - 3.5 X 14MM CORTICAL AR-8935-14,2600448,CDM,270,RC,C1713,HCPCS,outpatient,,,420,210,,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.28,38.4,,129.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,35,,117.6,percent of total billed charges,35% of total billed charges for outpatient setting,327.6,78,,262.08,percent of total billed charges,78% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,294,70,,235.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315,75,,252,percent of total billed charges,75% of total billed charges for outpatient setting,348.6,83,,278.88,percent of total billed charges,83% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,210,50,,168,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.51,39.17,,131.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147,348.6,
SCREW - 3.5 X 10MM LOCKING  AR-8935CL-10,2600449,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW - 3.5 X 12MM LOCKING  AR-8935CL-12,2600450,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW - 3.5 X 14MM LOCKING  AR-8935CL-14,2600451,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SCREW - 2.4 X 14MM  CORTICAL,2600452,CDM,270,RC,C1713,HCPCS,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
SCREW - 2.4 X 14MM LOCKING,2600453,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
SUTURE - MONOCRYL 4-0 PS-2 NEEDLE,2600454,CDM,270,RC,C1713,HCPCS,outpatient,,,360,180,,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,138.24,38.4,,110.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126,35,,100.8,percent of total billed charges,35% of total billed charges for outpatient setting,280.8,78,,224.64,percent of total billed charges,78% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,252,70,,201.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270,75,,216,percent of total billed charges,75% of total billed charges for outpatient setting,298.8,83,,239.04,percent of total billed charges,83% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,180,50,,144,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141,39.17,,112.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,126,298.8,
FILTER - ANGLED INLET HME W/CO2 PORT,2600455,CDM,270,RC,C1713,HCPCS,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.5,207.5,
B B TAK - AR-13226,2600456,CDM,270,RC,C1713,HCPCS,outpatient,,,250.5,125.25,,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.19,38.4,,76.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96.19,38.4,,76.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,187.88,75,,150.304,percent of total billed charges,75% of total billed charges for outpatient setting,187.88,75,,150.304,percent of total billed charges,75% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,187.88,75,,150.304,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.68,35,,70.144,percent of total billed charges,35% of total billed charges for outpatient setting,195.39,78,,156.312,percent of total billed charges,78% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,175.35,70,,140.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.88,75,,150.304,percent of total billed charges,75% of total billed charges for outpatient setting,207.92,83,,166.336,percent of total billed charges,83% of total billed charges for outpatient setting,125.25,50,,100.2,percent of total billed charges,50% of total billed charges for outpatient setting,125.25,50,,100.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.11,39.17,,78.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.68,207.92,
DRILL BIT -2.0  - AR-8943-16,2600457,CDM,270,RC,C1713,HCPCS,outpatient,,,477,238.5,,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.17,38.4,,146.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,183.17,38.4,,146.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,357.75,75,,286.2,percent of total billed charges,75% of total billed charges for outpatient setting,357.75,75,,286.2,percent of total billed charges,75% of total billed charges for outpatient setting,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,357.75,75,,286.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.95,35,,133.56,percent of total billed charges,35% of total billed charges for outpatient setting,372.06,78,,297.648,percent of total billed charges,78% of total billed charges for outpatient setting,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,333.9,70,,267.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,357.75,75,,286.2,percent of total billed charges,75% of total billed charges for outpatient setting,395.91,83,,316.728,percent of total billed charges,83% of total billed charges for outpatient setting,238.5,50,,190.8,percent of total billed charges,50% of total billed charges for outpatient setting,238.5,50,,190.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,186.83,39.17,,149.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,166.95,395.91,
DRILL BIT -2.5 - AR-8943-13,2600458,CDM,270,RC,C1713,HCPCS,outpatient,,,426,213,,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.58,38.4,,130.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.58,38.4,,130.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.1,35,,119.28,percent of total billed charges,35% of total billed charges for outpatient setting,332.28,78,,265.824,percent of total billed charges,78% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,298.2,70,,238.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,319.5,75,,255.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.58,83,,282.864,percent of total billed charges,83% of total billed charges for outpatient setting,213,50,,170.4,percent of total billed charges,50% of total billed charges for outpatient setting,213,50,,170.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.85,39.17,,133.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,149.1,353.58,
PLATE - RIGHT LOCKING LATERAL,2600459,CDM,270,RC,C1713,HCPCS,outpatient,,,9919,4959.5,,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3808.9,38.4,,3047.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3808.9,38.4,,3047.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,7439.25,75,,5951.4,percent of total billed charges,75% of total billed charges for outpatient setting,7439.25,75,,5951.4,percent of total billed charges,75% of total billed charges for outpatient setting,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,7439.25,75,,5951.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3471.65,35,,2777.32,percent of total billed charges,35% of total billed charges for outpatient setting,7736.82,78,,6189.456,percent of total billed charges,78% of total billed charges for outpatient setting,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,6943.3,70,,5554.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7439.25,75,,5951.4,percent of total billed charges,75% of total billed charges for outpatient setting,8232.77,83,,6586.216,percent of total billed charges,83% of total billed charges for outpatient setting,4959.5,50,,3967.6,percent of total billed charges,50% of total billed charges for outpatient setting,4959.5,50,,3967.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3885.08,39.17,,3108.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3471.65,8232.77,
SCREW - FRAGMENT 2.5X18   AR-2665-18H,2600460,CDM,270,RC,C1713,HCPCS,outpatient,,,2625,1312.5,,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1008,38.4,,806.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1008,38.4,,806.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,1968.75,75,,1575,percent of total billed charges,75% of total billed charges for outpatient setting,1968.75,75,,1575,percent of total billed charges,75% of total billed charges for outpatient setting,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,1968.75,75,,1575,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.75,35,,735,percent of total billed charges,35% of total billed charges for outpatient setting,2047.5,78,,1638,percent of total billed charges,78% of total billed charges for outpatient setting,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,1837.5,70,,1470,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1968.75,75,,1575,percent of total billed charges,75% of total billed charges for outpatient setting,2178.75,83,,1743,percent of total billed charges,83% of total billed charges for outpatient setting,1312.5,50,,1050,percent of total billed charges,50% of total billed charges for outpatient setting,1312.5,50,,1050,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1028.16,39.17,,822.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,918.75,2178.75,
SCREW - 2.7 X 12  LOCKING AR-8827CL-12,2600461,CDM,270,RC,C1713,HCPCS,outpatient,,,3444,1722,,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1322.5,38.4,,1058,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1322.5,38.4,,1058,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1205.4,35,,964.32,percent of total billed charges,35% of total billed charges for outpatient setting,2686.32,78,,2149.056,percent of total billed charges,78% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,2410.8,70,,1928.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2583,75,,2066.4,percent of total billed charges,75% of total billed charges for outpatient setting,2858.52,83,,2286.816,percent of total billed charges,83% of total billed charges for outpatient setting,1722,50,,1377.6,percent of total billed charges,50% of total billed charges for outpatient setting,1722,50,,1377.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1348.95,39.17,,1079.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1205.4,2858.52,
SCREW - 3.5 X 12  CORTICAL AR-8835-12,2600462,CDM,270,RC,C1713,HCPCS,outpatient,,,409.5,204.75,,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.25,38.4,,125.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.25,38.4,,125.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,307.13,75,,245.704,percent of total billed charges,75% of total billed charges for outpatient setting,307.13,75,,245.704,percent of total billed charges,75% of total billed charges for outpatient setting,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,307.13,75,,245.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.33,35,,114.664,percent of total billed charges,35% of total billed charges for outpatient setting,319.41,78,,255.528,percent of total billed charges,78% of total billed charges for outpatient setting,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,286.65,70,,229.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,307.13,75,,245.704,percent of total billed charges,75% of total billed charges for outpatient setting,339.89,83,,271.912,percent of total billed charges,83% of total billed charges for outpatient setting,204.75,50,,163.8,percent of total billed charges,50% of total billed charges for outpatient setting,204.75,50,,163.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.4,39.17,,128.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,143.33,339.89,
PENCIL - NEPTUNE SMOKE EVACUATION,2600463,CDM,270,RC,C1713,HCPCS,outpatient,,,1610,805,,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,618.24,38.4,,494.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,618.24,38.4,,494.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,1207.5,75,,966,percent of total billed charges,75% of total billed charges for outpatient setting,1207.5,75,,966,percent of total billed charges,75% of total billed charges for outpatient setting,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,1207.5,75,,966,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,563.5,35,,450.8,percent of total billed charges,35% of total billed charges for outpatient setting,1255.8,78,,1004.64,percent of total billed charges,78% of total billed charges for outpatient setting,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,1127,70,,901.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1207.5,75,,966,percent of total billed charges,75% of total billed charges for outpatient setting,1336.3,83,,1069.04,percent of total billed charges,83% of total billed charges for outpatient setting,805,50,,644,percent of total billed charges,50% of total billed charges for outpatient setting,805,50,,644,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,630.6,39.17,,504.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,563.5,1336.3,
NEEDLE - 20GA X 6 STIMUPLEX,2600464,CDM,270,RC,C1713,HCPCS,outpatient,,,942,471,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,361.73,38.4,,289.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,361.73,38.4,,289.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,329.7,35,,263.76,percent of total billed charges,35% of total billed charges for outpatient setting,734.76,78,,587.808,percent of total billed charges,78% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,781.86,83,,625.488,percent of total billed charges,83% of total billed charges for outpatient setting,471,50,,376.8,percent of total billed charges,50% of total billed charges for outpatient setting,471,50,,376.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.96,39.17,,295.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,329.7,781.86,
KNOTLESS SPEEDRIDGE IMPLANT SYSTEM/NEEDL,2600465,CDM,270,RC,C1713,HCPCS,outpatient,,,25088,12544,,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9633.79,38.4,,7707.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9633.79,38.4,,7707.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,18816,75,,15052.8,percent of total billed charges,75% of total billed charges for outpatient setting,18816,75,,15052.8,percent of total billed charges,75% of total billed charges for outpatient setting,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,18816,75,,15052.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8780.8,35,,7024.64,percent of total billed charges,35% of total billed charges for outpatient setting,19568.64,78,,15654.912,percent of total billed charges,78% of total billed charges for outpatient setting,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,17561.6,70,,14049.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18816,75,,15052.8,percent of total billed charges,75% of total billed charges for outpatient setting,20823.04,83,,16658.432,percent of total billed charges,83% of total billed charges for outpatient setting,12544,50,,10035.2,percent of total billed charges,50% of total billed charges for outpatient setting,12544,50,,10035.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9826.47,39.17,,7861.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8780.8,20823.04,
DRILL BIT - 3.2  AR-8737-35,2600469,CDM,270,RC,C1713,HCPCS,outpatient,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,35,,273,percent of total billed charges,35% of total billed charges for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.89,39.17,,305.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,341.25,809.25,
PROFILE  BIT - 3.5  AR-8737-47,2600470,CDM,270,RC,C1713,HCPCS,outpatient,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
DRILL  BIT - 2.2 AR-8737-34,2600471,CDM,270,RC,C1713,HCPCS,outpatient,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,374.4,38.4,,299.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,341.25,35,,273,percent of total billed charges,35% of total billed charges for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.89,39.17,,305.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,341.25,809.25,
PROFILE DRILL - AR-8737-46,2600472,CDM,270,RC,C1713,HCPCS,outpatient,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
K-WIRE - 1.1MM   AR-9938-04,2600473,CDM,270,RC,C1713,HCPCS,outpatient,,,201,100.5,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.35,35,,56.28,percent of total billed charges,35% of total billed charges for outpatient setting,156.78,78,,125.424,percent of total billed charges,78% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,166.83,83,,133.464,percent of total billed charges,83% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.72,39.17,,62.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70.35,166.83,
K-WIRE - 1.35MM   AR-9938-10,2600474,CDM,270,RC,C1713,HCPCS,outpatient,,,201,100.5,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.35,35,,56.28,percent of total billed charges,35% of total billed charges for outpatient setting,156.78,78,,125.424,percent of total billed charges,78% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,166.83,83,,133.464,percent of total billed charges,83% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.72,39.17,,62.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70.35,166.83,
SCREW - 2.5X18MM COMP FT AR-8725-18H,2600475,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
SCREW - 2.5X20MM COMP FT AR-8725-20H,2600476,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
SCREW - 3.5X22MM COMP FT AR-8730-22H,2600477,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
SCREW - 3.5X24MM COMP FT AR-8730-24H,2600478,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
SCREW - 3.5X18MM COMP FT AR-8730-18H,2600479,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
SCREW - 2.4 X 24MM CORTICAL,2600482,CDM,270,RC,C1713,HCPCS,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
SCREW - 2.4 X 22MM LOCKING,2600483,CDM,270,RC,C1713,HCPCS,outpatient,,,2065,1032.5,,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,792.96,38.4,,634.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,722.75,35,,578.2,percent of total billed charges,35% of total billed charges for outpatient setting,1610.7,78,,1288.56,percent of total billed charges,78% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,1445.5,70,,1156.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1548.75,75,,1239,percent of total billed charges,75% of total billed charges for outpatient setting,1713.95,83,,1371.16,percent of total billed charges,83% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,1032.5,50,,826,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,808.82,39.17,,647.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,722.75,1713.95,
ANCHOR - 2.9 JUGGER KNOT  # 912029,2600484,CDM,270,RC,C1713,HCPCS,outpatient,,,2047,1023.5,,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,786.05,38.4,,628.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,786.05,38.4,,628.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.45,35,,573.16,percent of total billed charges,35% of total billed charges for outpatient setting,1596.66,78,,1277.328,percent of total billed charges,78% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,1432.9,70,,1146.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1535.25,75,,1228.2,percent of total billed charges,75% of total billed charges for outpatient setting,1699.01,83,,1359.208,percent of total billed charges,83% of total billed charges for outpatient setting,1023.5,50,,818.8,percent of total billed charges,50% of total billed charges for outpatient setting,1023.5,50,,818.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,801.77,39.17,,641.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,716.45,1699.01,
KIT - 2.9 JUGGER KNOT DISP # 912057,2600485,CDM,270,RC,C1713,HCPCS,outpatient,,,1642,821,,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,630.53,38.4,,504.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,630.53,38.4,,504.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,1231.5,75,,985.2,percent of total billed charges,75% of total billed charges for outpatient setting,1231.5,75,,985.2,percent of total billed charges,75% of total billed charges for outpatient setting,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,1231.5,75,,985.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,574.7,35,,459.76,percent of total billed charges,35% of total billed charges for outpatient setting,1280.76,78,,1024.608,percent of total billed charges,78% of total billed charges for outpatient setting,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,1149.4,70,,919.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1231.5,75,,985.2,percent of total billed charges,75% of total billed charges for outpatient setting,1362.86,83,,1090.288,percent of total billed charges,83% of total billed charges for outpatient setting,821,50,,656.8,percent of total billed charges,50% of total billed charges for outpatient setting,821,50,,656.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.14,39.17,,514.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,574.7,1362.86,
SUTURE - VICRYL VCP603H 0,2600486,CDM,270,RC,C1713,HCPCS,outpatient,,,494,247,,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.7,38.4,,151.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.7,38.4,,151.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.9,35,,138.32,percent of total billed charges,35% of total billed charges for outpatient setting,385.32,78,,308.256,percent of total billed charges,78% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,345.8,70,,276.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,370.5,75,,296.4,percent of total billed charges,75% of total billed charges for outpatient setting,410.02,83,,328.016,percent of total billed charges,83% of total billed charges for outpatient setting,247,50,,197.6,percent of total billed charges,50% of total billed charges for outpatient setting,247,50,,197.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.49,39.17,,154.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,172.9,410.02,
SUTURE - VICRYL 4-0 VCP214H,2600487,CDM,270,RC,C1713,HCPCS,outpatient,,,375,187.5,,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144,38.4,,115.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144,38.4,,115.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.25,35,,105,percent of total billed charges,35% of total billed charges for outpatient setting,292.5,78,,234,percent of total billed charges,78% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,83,,249,percent of total billed charges,83% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.88,39.17,,117.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,131.25,311.25,
SYSTEM - OVAL DISSECTING BALLOON COK13,2600488,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
BLANKET - UB BAIR HUGGER,2600489,CDM,270,RC,C1713,HCPCS,outpatient,,,1752,876,,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.77,38.4,,538.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,613.2,35,,490.56,percent of total billed charges,35% of total billed charges for outpatient setting,1366.56,78,,1093.248,percent of total billed charges,78% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,1226.4,70,,981.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1314,75,,1051.2,percent of total billed charges,75% of total billed charges for outpatient setting,1454.16,83,,1163.328,percent of total billed charges,83% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,876,50,,700.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686.23,39.17,,548.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,613.2,1454.16,
K-WIRE - AR-18700-30,2600490,CDM,270,RC,C1713,HCPCS,outpatient,,,134,67,,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.46,38.4,,41.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.46,38.4,,41.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.9,35,,37.52,percent of total billed charges,35% of total billed charges for outpatient setting,104.52,78,,83.616,percent of total billed charges,78% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,93.8,70,,75.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.5,75,,80.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.22,83,,88.976,percent of total billed charges,83% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,67,50,,53.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.49,39.17,,41.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,46.9,111.22,
BB TAK  AR-18700-34,2600491,CDM,270,RC,C1713,HCPCS,outpatient,,,1000,500,,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,384,38.4,,307.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,384,38.4,,307.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,750,75,,600,percent of total billed charges,75% of total billed charges for outpatient setting,750,75,,600,percent of total billed charges,75% of total billed charges for outpatient setting,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,750,75,,600,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,350,35,,280,percent of total billed charges,35% of total billed charges for outpatient setting,780,78,,624,percent of total billed charges,78% of total billed charges for outpatient setting,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,700,70,,560,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,750,75,,600,percent of total billed charges,75% of total billed charges for outpatient setting,830,83,,664,percent of total billed charges,83% of total billed charges for outpatient setting,500,50,,400,percent of total billed charges,50% of total billed charges for outpatient setting,500,50,,400,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,391.68,39.17,,313.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,350,830,
DRILL BIT - 1.5MM  AR-18700-20,2600492,CDM,270,RC,C1713,HCPCS,outpatient,,,1068,534,,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,410.11,38.4,,328.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,410.11,38.4,,328.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,373.8,35,,299.04,percent of total billed charges,35% of total billed charges for outpatient setting,833.04,78,,666.432,percent of total billed charges,78% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,747.6,70,,598.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,801,75,,640.8,percent of total billed charges,75% of total billed charges for outpatient setting,886.44,83,,709.152,percent of total billed charges,83% of total billed charges for outpatient setting,534,50,,427.2,percent of total billed charges,50% of total billed charges for outpatient setting,534,50,,427.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,418.31,39.17,,334.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,373.8,886.44,
PLATE - 2.0 STRAIGHT 8 HOLE AR-18720P-26,2600493,CDM,270,RC,C1713,HCPCS,outpatient,,,9275,4637.5,,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3561.6,38.4,,2849.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3561.6,38.4,,2849.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6956.25,75,,5565,percent of total billed charges,75% of total billed charges for outpatient setting,6956.25,75,,5565,percent of total billed charges,75% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6956.25,75,,5565,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3246.25,35,,2597,percent of total billed charges,35% of total billed charges for outpatient setting,7234.5,78,,5787.6,percent of total billed charges,78% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,6492.5,70,,5194,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6956.25,75,,5565,percent of total billed charges,75% of total billed charges for outpatient setting,7698.25,83,,6158.6,percent of total billed charges,83% of total billed charges for outpatient setting,4637.5,50,,3710,percent of total billed charges,50% of total billed charges for outpatient setting,4637.5,50,,3710,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3632.83,39.17,,2906.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3246.25,7698.25,
SCREW - 2.0 X 9MM CORTICAL AR-18720-09,2600494,CDM,270,RC,C1713,HCPCS,outpatient,,,1288,644,,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,450.8,35,,360.64,percent of total billed charges,35% of total billed charges for outpatient setting,1004.64,78,,803.712,percent of total billed charges,78% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,1069.04,83,,855.232,percent of total billed charges,83% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,504.48,39.17,,403.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,450.8,1069.04,
SCREW - 2.0 X 11MM CORTICAL AR-18720-11,2600495,CDM,270,RC,C1713,HCPCS,outpatient,,,1288,644,,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,450.8,35,,360.64,percent of total billed charges,35% of total billed charges for outpatient setting,1004.64,78,,803.712,percent of total billed charges,78% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,1069.04,83,,855.232,percent of total billed charges,83% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,504.48,39.17,,403.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,450.8,1069.04,
SCREW - 2.0 X 12MM CORTICAL AR-18720-12,2600496,CDM,270,RC,C1713,HCPCS,outpatient,,,1288,644,,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,494.59,38.4,,395.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,450.8,35,,360.64,percent of total billed charges,35% of total billed charges for outpatient setting,1004.64,78,,803.712,percent of total billed charges,78% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,901.6,70,,721.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,966,75,,772.8,percent of total billed charges,75% of total billed charges for outpatient setting,1069.04,83,,855.232,percent of total billed charges,83% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,644,50,,515.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,504.48,39.17,,403.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,450.8,1069.04,
SCREW - 2.0 X 1MM LOCKING AR-18720V-11,2600497,CDM,270,RC,C1713,HCPCS,outpatient,,,1638,819,,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,628.99,38.4,,503.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,628.99,38.4,,503.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,1228.5,75,,982.8,percent of total billed charges,75% of total billed charges for outpatient setting,1228.5,75,,982.8,percent of total billed charges,75% of total billed charges for outpatient setting,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,1228.5,75,,982.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,573.3,35,,458.64,percent of total billed charges,35% of total billed charges for outpatient setting,1277.64,78,,1022.112,percent of total billed charges,78% of total billed charges for outpatient setting,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,1146.6,70,,917.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1228.5,75,,982.8,percent of total billed charges,75% of total billed charges for outpatient setting,1359.54,83,,1087.632,percent of total billed charges,83% of total billed charges for outpatient setting,819,50,,655.2,percent of total billed charges,50% of total billed charges for outpatient setting,819,50,,655.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,641.57,39.17,,513.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,573.3,1359.54,
NEEDLE - 21GA X 4 STIMUPLEX,2600498,CDM,270,RC,C1713,HCPCS,outpatient,,,1362.93,681.47,,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,523.37,38.4,,418.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,523.37,38.4,,418.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,1022.2,75,,817.76,percent of total billed charges,75% of total billed charges for outpatient setting,1022.2,75,,817.76,percent of total billed charges,75% of total billed charges for outpatient setting,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,1022.2,75,,817.76,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,477.03,35,,381.624,percent of total billed charges,35% of total billed charges for outpatient setting,1063.09,78,,850.472,percent of total billed charges,78% of total billed charges for outpatient setting,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,954.05,70,,763.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1022.2,75,,817.76,percent of total billed charges,75% of total billed charges for outpatient setting,1131.23,83,,904.984,percent of total billed charges,83% of total billed charges for outpatient setting,681.47,50,,545.176,percent of total billed charges,50% of total billed charges for outpatient setting,681.47,50,,545.176,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,533.84,39.17,,427.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,477.03,1131.23,
ANCHOR - JUGGERKNOT SOFT #912031,2600501,CDM,270,RC,C1713,HCPCS,outpatient,,,1673,836.5,,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,642.43,38.4,,513.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,642.43,38.4,,513.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,1254.75,75,,1003.8,percent of total billed charges,75% of total billed charges for outpatient setting,1254.75,75,,1003.8,percent of total billed charges,75% of total billed charges for outpatient setting,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,1254.75,75,,1003.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,585.55,35,,468.44,percent of total billed charges,35% of total billed charges for outpatient setting,1304.94,78,,1043.952,percent of total billed charges,78% of total billed charges for outpatient setting,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,1171.1,70,,936.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1254.75,75,,1003.8,percent of total billed charges,75% of total billed charges for outpatient setting,1388.59,83,,1110.872,percent of total billed charges,83% of total billed charges for outpatient setting,836.5,50,,669.2,percent of total billed charges,50% of total billed charges for outpatient setting,836.5,50,,669.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,655.28,39.17,,524.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,585.55,1388.59,
PLATE - 6 HOLE LATERAL ANKLE 3,2600502,CDM,270,RC,C1713,HCPCS,outpatient,,,6111,3055.5,,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2346.62,38.4,,1877.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2346.62,38.4,,1877.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,4583.25,75,,3666.6,percent of total billed charges,75% of total billed charges for outpatient setting,4583.25,75,,3666.6,percent of total billed charges,75% of total billed charges for outpatient setting,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,4583.25,75,,3666.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2138.85,35,,1711.08,percent of total billed charges,35% of total billed charges for outpatient setting,4766.58,78,,3813.264,percent of total billed charges,78% of total billed charges for outpatient setting,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,4277.7,70,,3422.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4583.25,75,,3666.6,percent of total billed charges,75% of total billed charges for outpatient setting,5072.13,83,,4057.704,percent of total billed charges,83% of total billed charges for outpatient setting,3055.5,50,,2444.4,percent of total billed charges,50% of total billed charges for outpatient setting,3055.5,50,,2444.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2393.55,39.17,,1914.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2138.85,5072.13,
SCREW - 3.5 X 12MM NON-LOCKING,2600503,CDM,270,RC,C1713,HCPCS,outpatient,,,574,287,,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,220.42,38.4,,176.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,220.42,38.4,,176.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,430.5,75,,344.4,percent of total billed charges,75% of total billed charges for outpatient setting,430.5,75,,344.4,percent of total billed charges,75% of total billed charges for outpatient setting,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,430.5,75,,344.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,200.9,35,,160.72,percent of total billed charges,35% of total billed charges for outpatient setting,447.72,78,,358.176,percent of total billed charges,78% of total billed charges for outpatient setting,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,401.8,70,,321.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,430.5,75,,344.4,percent of total billed charges,75% of total billed charges for outpatient setting,476.42,83,,381.136,percent of total billed charges,83% of total billed charges for outpatient setting,287,50,,229.6,percent of total billed charges,50% of total billed charges for outpatient setting,287,50,,229.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,224.83,39.17,,179.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,200.9,476.42,
SCREW - 2.7 X 14 MM LOCKING  30-0327,2600504,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW - 2.7 X 12MM LOCKING  30-0326,2600505,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
SCREW - 3.5 X 12MM LOCKING  30-0234,2600506,CDM,270,RC,C1713,HCPCS,outpatient,,,960,480,,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,368.64,38.4,,294.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,336,35,,268.8,percent of total billed charges,35% of total billed charges for outpatient setting,748.8,78,,599.04,percent of total billed charges,78% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,672,70,,537.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,720,75,,576,percent of total billed charges,75% of total billed charges for outpatient setting,796.8,83,,637.44,percent of total billed charges,83% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,480,50,,384,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,376.01,39.17,,300.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,336,796.8,
WIRE - 1.3 GUIDE  80-2039,2600507,CDM,270,RC,C1713,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
DRILL BIT - 2.7 CANNULATED 80-2075,2600508,CDM,270,RC,C1713,HCPCS,outpatient,,,1011,505.5,,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,388.22,38.4,,310.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,353.85,35,,283.08,percent of total billed charges,35% of total billed charges for outpatient setting,788.58,78,,630.864,percent of total billed charges,78% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,707.7,70,,566.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,758.25,75,,606.6,percent of total billed charges,75% of total billed charges for outpatient setting,839.13,83,,671.304,percent of total billed charges,83% of total billed charges for outpatient setting,505.5,50,,404.4,percent of total billed charges,50% of total billed charges for outpatient setting,505.5,50,,404.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,395.98,39.17,,316.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,353.85,839.13,
SCREW - 42MM CANNULATED 4.0 3006-40042,2600509,CDM,270,RC,C1713,HCPCS,outpatient,,,1043,521.5,,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,400.51,38.4,,320.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,400.51,38.4,,320.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.05,35,,292.04,percent of total billed charges,35% of total billed charges for outpatient setting,813.54,78,,650.832,percent of total billed charges,78% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,730.1,70,,584.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,782.25,75,,625.8,percent of total billed charges,75% of total billed charges for outpatient setting,865.69,83,,692.552,percent of total billed charges,83% of total billed charges for outpatient setting,521.5,50,,417.2,percent of total billed charges,50% of total billed charges for outpatient setting,521.5,50,,417.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,408.52,39.17,,326.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,365.05,865.69,
DRILL BIT - 2.8MM 80-2379,2600510,CDM,270,RC,C1713,HCPCS,outpatient,,,664,332,,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,254.98,38.4,,203.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,254.98,38.4,,203.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.4,35,,185.92,percent of total billed charges,35% of total billed charges for outpatient setting,517.92,78,,414.336,percent of total billed charges,78% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,551.12,83,,440.896,percent of total billed charges,83% of total billed charges for outpatient setting,332,50,,265.6,percent of total billed charges,50% of total billed charges for outpatient setting,332,50,,265.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,260.08,39.17,,208.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,232.4,551.12,
DRILL BIT - 3.0 MM 80-2378,2600511,CDM,270,RC,C1713,HCPCS,outpatient,,,664,332,,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,254.98,38.4,,203.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,254.98,38.4,,203.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.4,35,,185.92,percent of total billed charges,35% of total billed charges for outpatient setting,517.92,78,,414.336,percent of total billed charges,78% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,464.8,70,,371.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498,75,,398.4,percent of total billed charges,75% of total billed charges for outpatient setting,551.12,83,,440.896,percent of total billed charges,83% of total billed charges for outpatient setting,332,50,,265.6,percent of total billed charges,50% of total billed charges for outpatient setting,332,50,,265.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,260.08,39.17,,208.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,232.4,551.12,
NEEDLE - 22GX 3.5IN QUINCKE SPINAL,2600512,CDM,270,RC,C1713,HCPCS,outpatient,,,137.66,68.83,,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.86,38.4,,42.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.86,38.4,,42.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,103.25,75,,82.6,percent of total billed charges,75% of total billed charges for outpatient setting,103.25,75,,82.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,103.25,75,,82.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.18,35,,38.544,percent of total billed charges,35% of total billed charges for outpatient setting,107.37,78,,85.896,percent of total billed charges,78% of total billed charges for outpatient setting,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,96.36,70,,77.088,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.25,75,,82.6,percent of total billed charges,75% of total billed charges for outpatient setting,114.26,83,,91.408,percent of total billed charges,83% of total billed charges for outpatient setting,68.83,50,,55.064,percent of total billed charges,50% of total billed charges for outpatient setting,68.83,50,,55.064,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.92,39.17,,43.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,48.18,114.26,
PATH LEVEL I,2900000,CDM,312,RC,88300,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,14.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.02,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.01,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.01,72.21,
PATH LEVEL II,2900001,CDM,312,RC,88302,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,35.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,35.06,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.54,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.54,62.25,
PATH LEVEL III,2900002,CDM,312,RC,88304,HCPCS,outpatient,,,333,166.5,,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,30.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,30.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.69,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,259.74,78,,207.792,percent of total billed charges,78% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,276.39,83,,221.112,percent of total billed charges,83% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.13,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.13,276.39,
PATH LEVEL IV,2900003,CDM,312,RC,88305,HCPCS,outpatient,,,333,166.5,,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,259.74,78,,207.792,percent of total billed charges,78% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,276.39,83,,221.112,percent of total billed charges,83% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.12,276.39,
PATH LEVEL V,2900004,CDM,312,RC,88307,HCPCS,outpatient,,,795,397.5,,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,133.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,133.3,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,596.25,75,,477,percent of total billed charges,75% of total billed charges for outpatient setting,596.25,75,,477,percent of total billed charges,75% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,596.25,75,,477,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,139.97,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,620.1,78,,496.08,percent of total billed charges,78% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,556.5,70,,445.2,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,596.25,75,,477,percent of total billed charges,75% of total billed charges for outpatient setting,659.85,83,,527.88,percent of total billed charges,83% of total billed charges for outpatient setting,397.5,50,,318,percent of total billed charges,50% of total billed charges for outpatient setting,397.5,50,,318,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.31,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.31,659.85,
PATH LEVEL VI,2900005,CDM,312,RC,88309,HCPCS,outpatient,,,984,492,,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,187.78,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,738,75,,590.4,percent of total billed charges,75% of total billed charges for outpatient setting,738,75,,590.4,percent of total billed charges,75% of total billed charges for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,738,75,,590.4,percent of total billed charges,75% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,767.52,78,,614.016,percent of total billed charges,78% of total billed charges for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,688.8,70,,551.04,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738,75,,590.4,percent of total billed charges,75% of total billed charges for outpatient setting,816.72,83,,653.376,percent of total billed charges,83% of total billed charges for outpatient setting,492,50,,393.6,percent of total billed charges,50% of total billed charges for outpatient setting,492,50,,393.6,percent of total billed charges,50% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.45,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.45,816.72,
DECALCIFICATION,2900006,CDM,312,RC,88311,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,15.45,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.22,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.82,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.82,54.78,
SPECIAL STAINS GP 1,2900007,CDM,312,RC,88312,HCPCS,outpatient,,,283,141.5,,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,43.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,43.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.56,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,220.74,78,,176.592,percent of total billed charges,78% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,198.1,70,,158.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.25,75,,169.8,percent of total billed charges,75% of total billed charges for outpatient setting,234.89,83,,187.912,percent of total billed charges,83% of total billed charges for outpatient setting,141.5,50,,113.2,percent of total billed charges,50% of total billed charges for outpatient setting,141.5,50,,113.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.37,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.37,234.89,
SPECIAL STAINS GP 2,2900008,CDM,312,RC,88313,HCPCS,outpatient,,,166,83,,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.91,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,44.91,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,129.48,78,,103.584,percent of total billed charges,78% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,116.2,70,,92.96,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.5,75,,99.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.78,83,,110.224,percent of total billed charges,83% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,83,50,,66.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.44,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.44,137.78,
PATH CONSULT/SURGERY,2900009,CDM,312,RC,88329,HCPCS,outpatient,,,95,47.5,,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,36.87,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.71,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,74.1,78,,59.28,percent of total billed charges,78% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,78.85,83,,63.08,percent of total billed charges,83% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.81,78.85,
CONSULT FROZEN SECTI,2900010,CDM,312,RC,88331,HCPCS,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,74.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.76,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.33,199.2,
ADD'L TISSUE BLOCK,2900011,CDM,312,RC,88332,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,37.53,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.41,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.27,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.27,107.9,
IMMUNOCYTOCHEMISTRY,2900012,CDM,312,RC,88342,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,71.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.11,214.14,
FILTER PREP,2900013,CDM,311,RC,88106,HCPCS,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,38.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,38.24,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.15,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,128.65,
FILTER AND SMEAR,2900014,CDM,311,RC,88107,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,31.5,50,,25.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.05,52.29,
>5 SMEARS PER CASE,2900015,CDM,311,RC,88162,HCPCS,outpatient,,,242,121,,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.76,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,188.76,78,,151.008,percent of total billed charges,78% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.86,83,,160.688,percent of total billed charges,83% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.17,200.86,
SMEAR ONLY,2900017,CDM,311,RC,88104,HCPCS,outpatient,,,181,90.5,,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,42.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,42.68,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.81,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,141.18,78,,112.944,percent of total billed charges,78% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.23,83,,120.184,percent of total billed charges,83% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.88,150.23,
CYTOSPIN,2900018,CDM,311,RC,88162,HCPCS,outpatient,,,242,121,,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,58.82,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.76,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,188.76,78,,151.008,percent of total billed charges,78% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,169.4,70,,135.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,181.5,75,,145.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.86,83,,160.688,percent of total billed charges,83% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,121,50,,96.8,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.17,200.86,
CELL BLOCK,2900019,CDM,312,RC,88305,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,65.88,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.17,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.12,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.12,140.27,
BONE MARROW BIOPSY,2900021,CDM,360,RC,38221,HCPCS,outpatient,,,1979,989.5,,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,759.94,38.4,,607.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,759.94,38.4,,607.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1484.25,75,,1187.4,percent of total billed charges,75% of total billed charges for outpatient setting,1484.25,75,,1187.4,percent of total billed charges,75% of total billed charges for outpatient setting,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1484.25,75,,1187.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,692.65,35,,554.12,percent of total billed charges,35% of total billed charges for outpatient setting,1543.62,78,,1234.896,percent of total billed charges,78% of total billed charges for outpatient setting,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1385.3,70,,1108.24,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1484.25,75,,1187.4,percent of total billed charges,75% of total billed charges for outpatient setting,1642.57,83,,1314.056,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,775.14,39.17,,620.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,692.65,1642.57,
BONE MARROW SMEAR INT,2900022,CDM,360,RC,85097,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,49.33,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.33,738.62,
CYTOGENETICS,2900023,CDM,312,RC,88291,HCPCS,outpatient,,,206,103,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.39,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.66,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,160.68,78,,128.544,percent of total billed charges,78% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,170.98,83,,136.784,percent of total billed charges,83% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.77,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.77,170.98,
DNA PROBE EACH,2900024,CDM,312,RC,88271,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,21.42,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,26.94,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.29,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.86,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,21.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.86,75.53,
IN SITU HYBRIDIZATION,2900025,CDM,312,RC,88275,HCPCS,outpatient,,,171,85.5,,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,51.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,50.5,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,133.38,78,,106.704,percent of total billed charges,78% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,119.7,70,,95.76,percent of total billed charges,70% of total billed charges for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.25,75,,102.6,percent of total billed charges,75% of total billed charges for outpatient setting,141.93,83,,113.544,percent of total billed charges,83% of total billed charges for outpatient setting,85.5,50,,68.4,percent of total billed charges,50% of total billed charges for outpatient setting,85.5,50,,68.4,percent of total billed charges,50% of total billed charges for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.35,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,51.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.35,141.93,
"TISSUE CULTURE,BONE MARROW",2900026,CDM,312,RC,88237,HCPCS,outpatient,,,375,187.5,,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,143.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,111.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,111.02,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,116.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,292.5,78,,234,percent of total billed charges,78% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,83,,249,percent of total billed charges,83% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,143.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.71,311.25,
CHROMOSOME KARYOTYPE STUDY,2900028,CDM,312,RC,88280,HCPCS,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,31.56,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.14,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,33.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.09,89.64,
"CHROMOSOME ANALYSIS, 20-25",2900029,CDM,312,RC,88264,HCPCS,outpatient,,,529,264.5,,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,144.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,156.73,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,396.75,75,,317.4,percent of total billed charges,75% of total billed charges for outpatient setting,396.75,75,,317.4,percent of total billed charges,75% of total billed charges for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,396.75,75,,317.4,percent of total billed charges,75% of total billed charges for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.57,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,412.62,78,,330.096,percent of total billed charges,78% of total billed charges for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,370.3,70,,296.24,percent of total billed charges,70% of total billed charges for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,396.75,75,,317.4,percent of total billed charges,75% of total billed charges for outpatient setting,439.07,83,,351.256,percent of total billed charges,83% of total billed charges for outpatient setting,264.5,50,,211.6,percent of total billed charges,50% of total billed charges for outpatient setting,264.5,50,,211.6,percent of total billed charges,50% of total billed charges for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,144.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.71,439.07,
"CYTOPATH, CELL ENHANCE TECH",2900030,CDM,312,RC,88112,HCPCS,outpatient,,,333,166.5,,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.19,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.5,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,259.74,78,,207.792,percent of total billed charges,78% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,233.1,70,,186.48,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.75,75,,199.8,percent of total billed charges,75% of total billed charges for outpatient setting,276.39,83,,221.112,percent of total billed charges,83% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,166.5,50,,133.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.33,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,276.39,
TUMOR INNUNOHISTIOCHEM/MANUAL,2900031,CDM,312,RC,88360,HCPCS,outpatient,,,607,303.5,,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,97.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,97.65,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,455.25,75,,364.2,percent of total billed charges,75% of total billed charges for outpatient setting,455.25,75,,364.2,percent of total billed charges,75% of total billed charges for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,455.25,75,,364.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.53,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,473.46,78,,378.768,percent of total billed charges,78% of total billed charges for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,424.9,70,,339.92,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,455.25,75,,364.2,percent of total billed charges,75% of total billed charges for outpatient setting,503.81,83,,403.048,percent of total billed charges,83% of total billed charges for outpatient setting,303.5,50,,242.8,percent of total billed charges,50% of total billed charges for outpatient setting,303.5,50,,242.8,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.36,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.36,503.81,
"INSITU HYBRIDIZATION,AUTO",2900032,CDM,312,RC,88367,HCPCS,outpatient,,,523,261.5,,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,187.35,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,392.25,75,,313.8,percent of total billed charges,75% of total billed charges for outpatient setting,392.25,75,,313.8,percent of total billed charges,75% of total billed charges for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,392.25,75,,313.8,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,196.72,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,407.94,78,,326.352,percent of total billed charges,78% of total billed charges for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,366.1,70,,292.88,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,392.25,75,,313.8,percent of total billed charges,75% of total billed charges for outpatient setting,434.09,83,,347.272,percent of total billed charges,83% of total billed charges for outpatient setting,261.5,50,,209.2,percent of total billed charges,50% of total billed charges for outpatient setting,261.5,50,,209.2,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.15,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,131.15,434.09,
CYTOPATH CONCENTRATE TECH,2900033,CDM,312,RC,88108,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,45.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,45.74,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.03,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,76,50,,60.8,percent of total billed charges,50% of total billed charges for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.02,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,34.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.02,126.16,
IMMUNOHISTOCHEMISTRY,2900034,CDM,312,RC,88342,HCPCS,outpatient,,,517,258.5,,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,71.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,71.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,403.26,78,,322.608,percent of total billed charges,78% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,361.9,70,,289.52,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,387.75,75,,310.2,percent of total billed charges,75% of total billed charges for outpatient setting,429.11,83,,343.288,percent of total billed charges,83% of total billed charges for outpatient setting,258.5,50,,206.8,percent of total billed charges,50% of total billed charges for outpatient setting,258.5,50,,206.8,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.11,429.11,
B-CELL IGH CLONALITY ASSAY,2900035,CDM,312,RC,81261,HCPCS,outpatient,,,699,349.5,,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,197.99,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,244,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,244,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,256.2,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,545.22,78,,436.176,percent of total billed charges,78% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,489.3,70,,391.44,percent of total billed charges,70% of total billed charges for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,524.25,75,,419.4,percent of total billed charges,75% of total billed charges for outpatient setting,580.17,83,,464.136,percent of total billed charges,83% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,349.5,50,,279.6,percent of total billed charges,50% of total billed charges for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.8,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,197.99,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.8,580.17,
MICRODESSERTION,2900036,CDM,312,RC,88361,HCPCS,outpatient,,,375,187.5,,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,122.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,292.5,78,,234,percent of total billed charges,78% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,83,,249,percent of total billed charges,83% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.6,311.25,
CD20 CLONE L26 B CELL IMMUNOHI,2900037,CDM,312,RC,G0461,HCPCS,outpatient,,,114,57,,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.78,38.4,,35.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.9,35,,31.92,percent of total billed charges,35% of total billed charges for outpatient setting,88.92,78,,71.136,percent of total billed charges,78% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,79.8,70,,63.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.5,75,,68.4,percent of total billed charges,75% of total billed charges for outpatient setting,94.62,83,,75.696,percent of total billed charges,83% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,57,50,,45.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.66,39.17,,35.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.9,94.62,
CD3 T CELL MARKER IMMUNOHISTOC,2900038,CDM,312,RC,G0462,HCPCS,outpatient,,,124,62,,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.4,35,,34.72,percent of total billed charges,35% of total billed charges for outpatient setting,96.72,78,,77.376,percent of total billed charges,78% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,102.92,83,,82.336,percent of total billed charges,83% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.57,39.17,,38.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.4,102.92,
INSITU HYBRIDIZATION (FISH),2900039,CDM,312,RC,88365,HCPCS,outpatient,,,424,212,,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,88.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,88.18,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.59,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,330.72,78,,264.576,percent of total billed charges,78% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,296.8,70,,237.44,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318,75,,254.4,percent of total billed charges,75% of total billed charges for outpatient setting,351.92,83,,281.536,percent of total billed charges,83% of total billed charges for outpatient setting,212,50,,169.6,percent of total billed charges,50% of total billed charges for outpatient setting,212,50,,169.6,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.73,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.73,351.92,
IMMUNOFLUOR DIRECT TECH FEE,2900040,CDM,312,RC,88346,HCPCS,outpatient,,,229,114.5,,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,70.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,70.93,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.48,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,178.62,78,,142.896,percent of total billed charges,78% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,190.07,83,,152.056,percent of total billed charges,83% of total billed charges for outpatient setting,114.5,50,,91.6,percent of total billed charges,50% of total billed charges for outpatient setting,114.5,50,,91.6,percent of total billed charges,50% of total billed charges for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.65,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,146.71,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.65,190.07,
EM TECH FEE,2900041,CDM,312,RC,88348,HCPCS,outpatient,,,828,414,,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,279.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,279.47,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,621,75,,496.8,percent of total billed charges,75% of total billed charges for outpatient setting,621,75,,496.8,percent of total billed charges,75% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,621,75,,496.8,percent of total billed charges,75% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,293.44,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,645.84,78,,516.672,percent of total billed charges,78% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,579.6,70,,463.68,percent of total billed charges,70% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,621,75,,496.8,percent of total billed charges,75% of total billed charges for outpatient setting,687.24,83,,549.792,percent of total billed charges,83% of total billed charges for outpatient setting,414,50,,331.2,percent of total billed charges,50% of total billed charges for outpatient setting,414,50,,331.2,percent of total billed charges,50% of total billed charges for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.63,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,738.62,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,195.63,738.62,
"CYOPATH, FNA FINAL",2900042,CDM,312,RC,88173,HCPCS,outpatient,,,448,224,,313.6,70,,250.88,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,91.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,91.58,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,74.89,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.16,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,349.44,78,,279.552,percent of total billed charges,78% of total billed charges for outpatient setting,313.6,70,,250.88,percent of total billed charges,70% of total billed charges for outpatient setting,313.6,70,,250.88,percent of total billed charges,70% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336,75,,268.8,percent of total billed charges,75% of total billed charges for outpatient setting,371.84,83,,297.472,percent of total billed charges,83% of total billed charges for outpatient setting,224,50,,179.2,percent of total billed charges,50% of total billed charges for outpatient setting,224,50,,179.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.11,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,46.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.54,371.84,
SCREEN CERV/VAG THIN LAYER,2900043,CDM,312,RC,G0123,HCPCS,outpatient,,,142,71,,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,20.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,25.48,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.75,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,110.76,78,,88.608,percent of total billed charges,78% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,99.4,70,,79.52,percent of total billed charges,70% of total billed charges for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.5,75,,85.2,percent of total billed charges,75% of total billed charges for outpatient setting,117.86,83,,94.288,percent of total billed charges,83% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,71,50,,56.8,percent of total billed charges,50% of total billed charges for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,20.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,117.86,
EACH ADD SINGLE AB STAIN PROCE,2900044,CDM,312,RC,88341,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,57.38,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.25,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.17,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.17,181.77,
MICRODISSECTION,2910036,CDM,312,RC,88361,HCPCS,outpatient,,,375,187.5,,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,122.28,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.39,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,292.5,78,,234,percent of total billed charges,78% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,70,,210,percent of total billed charges,70% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,281.25,75,,225,percent of total billed charges,75% of total billed charges for outpatient setting,311.25,83,,249,percent of total billed charges,83% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,187.5,50,,150,percent of total billed charges,50% of total billed charges for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.6,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,308.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.6,311.25,
TZANK SMEAR,2979109,CDM,311,RC,88161,HCPCS,outpatient,,,159,79.5,,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,34.89,100,,,fee schedule,100% GA Medicaid fee schedule for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,119.25,75,,95.4,percent of total billed charges,75% of total billed charges for outpatient setting,119.25,75,,95.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,119.25,75,,95.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.63,105,,,fee schedule,105% GA Medicaid fee schedule for outpatient setting,124.02,78,,99.216,percent of total billed charges,78% of total billed charges for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,111.3,70,,89.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.25,75,,95.4,percent of total billed charges,75% of total billed charges for outpatient setting,131.97,83,,105.576,percent of total billed charges,83% of total billed charges for outpatient setting,79.5,50,,63.6,percent of total billed charges,50% of total billed charges for outpatient setting,79.5,50,,63.6,percent of total billed charges,50% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.42,102,,,fee schedule,102% GA Medicaid fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.42,131.97,
ONCOLOGY TREATMENT R,3040001,CDM,761,RC,99220,HCPCS,outpatient,,,472,236,,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.2,35,,132.16,percent of total billed charges,35% of total billed charges for outpatient setting,368.16,78,,294.528,percent of total billed charges,78% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,391.76,83,,313.408,percent of total billed charges,83% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.88,39.17,,147.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,165.2,391.76,
OC CHEMO ADM SUBQ/IM,3040002,CDM,335,RC,96401,HCPCS,outpatient,,,177,88.5,,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,67.97,38.4,,54.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.97,38.4,,54.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.95,35,,49.56,percent of total billed charges,35% of total billed charges for outpatient setting,138.06,78,,110.448,percent of total billed charges,78% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,123.9,70,,99.12,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132.75,75,,106.2,percent of total billed charges,75% of total billed charges for outpatient setting,146.91,83,,117.528,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,69.33,39.17,,55.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,424,
OC CHEMO ADM IV PUSH,3040003,CDM,335,RC,96409,HCPCS,outpatient,,,678,339,,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,260.35,38.4,,208.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,260.35,38.4,,208.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,237.3,35,,189.84,percent of total billed charges,35% of total billed charges for outpatient setting,528.84,78,,423.072,percent of total billed charges,78% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,474.6,70,,379.68,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,508.5,75,,406.8,percent of total billed charges,75% of total billed charges for outpatient setting,562.74,83,,450.192,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.56,39.17,,212.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,237.3,562.74,
OC CHEMO ADM INFUSION UP TO 1 HOU,3040004,CDM,335,RC,96413,HCPCS,outpatient,,,1074,537,,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,375.9,35,,300.72,percent of total billed charges,35% of total billed charges for outpatient setting,837.72,78,,670.176,percent of total billed charges,78% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.42,83,,713.136,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,420.67,39.17,,336.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,891.42,
CHEMO INFUSION 2 HRS,3040005,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 3 HRS,3040006,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 4 HRS,3040007,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 5 HRS,3040008,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 6HRS,3040009,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 7 HRS,3040010,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO INFUSION 8 HRS,3040011,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
INFUSION >8HRS @ PUM,3040012,CDM,335,RC,96416,HCPCS,outpatient,,,617,308.5,,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,236.93,38.4,,189.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,236.93,38.4,,189.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.95,35,,172.76,percent of total billed charges,35% of total billed charges for outpatient setting,481.26,78,,385.008,percent of total billed charges,78% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,512.11,83,,409.688,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,241.67,39.17,,193.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.95,512.11,
INFUS I/A >8HRS @ PU,3040022,CDM,335,RC,,,outpatient,,,556,278,,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.5,38.4,,170.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,194.6,35,,155.68,percent of total billed charges,35% of total billed charges for outpatient setting,433.68,78,,346.944,percent of total billed charges,78% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,389.2,70,,311.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,417,75,,333.6,percent of total billed charges,75% of total billed charges for outpatient setting,461.48,83,,369.184,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.77,39.17,,174.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,194.6,461.48,
REFILLING/MAINT PUMP,3040026,CDM,335,RC,96521,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,424,
OC ACCESSING IMPLANTED PORT,3040027,CDM,260,RC,96522,HCPCS,outpatient,,,521,260.5,,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,200.06,38.4,,160.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.06,38.4,,160.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,390.75,75,,312.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.75,75,,312.6,percent of total billed charges,75% of total billed charges for outpatient setting,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,390.75,75,,312.6,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.35,35,,145.88,percent of total billed charges,35% of total billed charges for outpatient setting,406.38,78,,325.104,percent of total billed charges,78% of total billed charges for outpatient setting,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,364.7,70,,291.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,390.75,75,,312.6,percent of total billed charges,75% of total billed charges for outpatient setting,432.43,83,,345.944,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,204.06,39.17,,163.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.35,432.43,
CHEMO INJECTION,3040028,CDM,335,RC,,,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,424,
ONCOLOGY NEW PT VISI,3040029,CDM,510,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
ONCOLOGY NEW PT VISI,3040030,CDM,510,RC,G0463,HCPCS,outpatient,,,234,117,,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.86,38.4,,71.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,35,,65.52,percent of total billed charges,35% of total billed charges for outpatient setting,182.52,78,,146.016,percent of total billed charges,78% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,163.8,70,,131.04,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,175.5,75,,140.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.22,83,,155.376,percent of total billed charges,83% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,117,50,,93.6,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.66,39.17,,73.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,81.9,194.22,
ONCOLOGY NEW PT VISI,3040031,CDM,510,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
ONCOLOGY EST PATIENT,3040032,CDM,510,RC,G0463,HCPCS,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.3,113.54,
ONCOLOGY EST PATIENT,3040033,CDM,510,RC,G0463,HCPCS,outpatient,,,148,74,,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.8,35,,41.44,percent of total billed charges,35% of total billed charges for outpatient setting,115.44,78,,92.352,percent of total billed charges,78% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.84,83,,98.272,percent of total billed charges,83% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.97,39.17,,46.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.8,122.84,
ONCOLOGY EST PATIENT,3040034,CDM,510,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
OC IV INFUSION 1 HOUR,3040036,CDM,510,RC,96365,HCPCS,outpatient,,,703,351.5,,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.05,35,,196.84,percent of total billed charges,35% of total billed charges for outpatient setting,548.34,78,,438.672,percent of total billed charges,78% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,583.49,83,,466.792,percent of total billed charges,83% of total billed charges for outpatient setting,351.5,50,,281.2,percent of total billed charges,50% of total billed charges for outpatient setting,351.5,50,,281.2,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.35,39.17,,220.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,583.49,
OC IV INFUSION EACH ADD HOUR,3040037,CDM,510,RC,96366,HCPCS,outpatient,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,149.4,
EVALUATION MANAGEMENT MED ONLY,3040038,CDM,510,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
CHEMO ADM INFUSION,3040040,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
BONE MARROW BIOPSY,3040041,CDM,360,RC,38221,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
BONE BIOPSY,3040042,CDM,360,RC,20220,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
BONE MARROW ASPIRATE,3040043,CDM,360,RC,38220,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1452,
EVALUATION/ MANAGEMENT LEVEL 1,3040044,CDM,761,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
EVALUATION/ MANAGEMENT LEVEL 2,3040045,CDM,761,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,106.24,
EVALUATION/ MANAGEMENT LEVEL 3,3040046,CDM,510,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
EVALUATION/ MANAGEMENT LEVEL 4,3040047,CDM,761,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
EVALUATION/ MANAGEMENT LEVEL 5,3040048,CDM,761,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
OC EVALUATION/ MANAGEMENT LEVEL 1,3040049,CDM,761,RC,99211,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,64.74,
OC EVALUATION/ MANAGEMENT LEVEL 2,3040050,CDM,761,RC,99212,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,64.74,
OC EVALUATION/ MANAGEMENT LEVEL 3,3040051,CDM,761,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
OC EVALUATION/ MANAGEMENT LEVEL 4,3040052,CDM,761,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
OC EVALUATION/ MANAGEMENT LEVEL 5,3040053,CDM,761,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
CHEMO CONSULTATION CONFERENCE,3040054,CDM,331,RC,G0175,HCPCS,outpatient,,,676,338,,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,259.58,38.4,,207.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.58,38.4,,207.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,507,75,,405.6,percent of total billed charges,75% of total billed charges for outpatient setting,507,75,,405.6,percent of total billed charges,75% of total billed charges for outpatient setting,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,507,75,,405.6,percent of total billed charges,75% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,236.6,35,,189.28,percent of total billed charges,35% of total billed charges for outpatient setting,527.28,78,,421.824,percent of total billed charges,78% of total billed charges for outpatient setting,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,473.2,70,,378.56,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,507,75,,405.6,percent of total billed charges,75% of total billed charges for outpatient setting,561.08,83,,448.864,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,264.77,39.17,,211.816,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,236.6,561.08,
OC IRRIGATION OF IMPLANTED DEVICE,3040055,CDM,360,RC,96523,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,69.72,
OC IV INFUSION ADD SEQUENTIAL INF,3040060,CDM,510,RC,96367,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
OC ADDITIONAL IV PUSH THER/PROPA,3040061,CDM,510,RC,96375,HCPCS,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.9,35,,15.12,percent of total billed charges,35% of total billed charges for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.15,39.17,,16.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.9,44.82,
OC IRRIGATION OF IMPLANTED DEVICE,3040062,CDM,335,RC,96523,HCPCS,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.4,424,
OC IV INFUSION HYDRATION,3040063,CDM,510,RC,96360,HCPCS,outpatient,,,458,229,,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.3,35,,128.24,percent of total billed charges,35% of total billed charges for outpatient setting,357.24,78,,285.792,percent of total billed charges,78% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,380.14,83,,304.112,percent of total billed charges,83% of total billed charges for outpatient setting,229,50,,183.2,percent of total billed charges,50% of total billed charges for outpatient setting,229,50,,183.2,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,179.39,39.17,,143.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,160.3,380.14,
OC IV HYDRATION EACH ADD HOUR,3040064,CDM,510,RC,96361,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,106.24,
IV START AND MONITOR 7 HR,3040065,CDM,260,RC,96365,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,293.82,
IV START AND MONITOR 8 HR,3040066,CDM,260,RC,96365,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,293.82,
IV INJECTION THERAPEUTIC,3040067,CDM,510,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
OC CHEMO ADM INFUSION EACH ADD'L,3040068,CDM,335,RC,96415,HCPCS,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.85,35,,53.48,percent of total billed charges,35% of total billed charges for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.81,39.17,,59.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,424,
CHEMO ADM INFUSION/IV PUSH UP,3040069,CDM,335,RC,96413,HCPCS,outpatient,,,617,308.5,,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,236.93,38.4,,189.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,236.93,38.4,,189.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.95,35,,172.76,percent of total billed charges,35% of total billed charges for outpatient setting,481.26,78,,385.008,percent of total billed charges,78% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,431.9,70,,345.52,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462.75,75,,370.2,percent of total billed charges,75% of total billed charges for outpatient setting,512.11,83,,409.688,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,241.67,39.17,,193.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.95,512.11,
CHEMO ADM INFUSION/IV PUSH EAC,3040070,CDM,335,RC,96415,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO IV PUSH (E),3040071,CDM,335,RC,96409,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,290.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,424,
ONCOLOGY OUTPATIENT CONSULT LE,3040072,CDM,510,RC,99243,HCPCS,outpatient,,,243,121.5,,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.05,35,,68.04,percent of total billed charges,35% of total billed charges for outpatient setting,189.54,78,,151.632,percent of total billed charges,78% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.69,83,,161.352,percent of total billed charges,83% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.18,39.17,,76.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.05,201.69,
ONCOLOGY OUTPATIENT CONSULT LE,3040073,CDM,510,RC,99244,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
ONCOLOGY OUTPATIENT CONSULT LE,3040074,CDM,510,RC,99245,HCPCS,outpatient,,,483,241.5,,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.05,35,,135.24,percent of total billed charges,35% of total billed charges for outpatient setting,376.74,78,,301.392,percent of total billed charges,78% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,400.89,83,,320.712,percent of total billed charges,83% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.18,39.17,,151.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,169.05,400.89,
PUNCTURE OF RESERVIOR FOR ASPI,3040075,CDM,360,RC,61070,HCPCS,outpatient,,,961,480.5,,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,369.02,38.4,,295.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,369.02,38.4,,295.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,720.75,75,,576.6,percent of total billed charges,75% of total billed charges for outpatient setting,720.75,75,,576.6,percent of total billed charges,75% of total billed charges for outpatient setting,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,720.75,75,,576.6,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.35,35,,269.08,percent of total billed charges,35% of total billed charges for outpatient setting,749.58,78,,599.664,percent of total billed charges,78% of total billed charges for outpatient setting,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,672.7,70,,538.16,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,720.75,75,,576.6,percent of total billed charges,75% of total billed charges for outpatient setting,797.63,83,,638.104,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,376.4,39.17,,301.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.35,1452,
ONCOLOGY INPATIENT CONSULT LEV,3040076,CDM,510,RC,99253,HCPCS,outpatient,,,292,146,,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.13,38.4,,89.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.13,38.4,,89.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.2,35,,81.76,percent of total billed charges,35% of total billed charges for outpatient setting,227.76,78,,182.208,percent of total billed charges,78% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,242.36,83,,193.888,percent of total billed charges,83% of total billed charges for outpatient setting,146,50,,116.8,percent of total billed charges,50% of total billed charges for outpatient setting,146,50,,116.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.37,39.17,,91.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.2,242.36,
ONCOLOGY INPATIENT CONSULT LEV,3040077,CDM,510,RC,99254,HCPCS,outpatient,,,423,211.5,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.43,38.4,,129.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.43,38.4,,129.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.05,35,,118.44,percent of total billed charges,35% of total billed charges for outpatient setting,329.94,78,,263.952,percent of total billed charges,78% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,351.09,83,,280.872,percent of total billed charges,83% of total billed charges for outpatient setting,211.5,50,,169.2,percent of total billed charges,50% of total billed charges for outpatient setting,211.5,50,,169.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.68,39.17,,132.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.05,351.09,
ONCOLOGY INPATIENT CONSULT LEV,3040078,CDM,510,RC,99255,HCPCS,outpatient,,,511,255.5,,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.85,35,,143.08,percent of total billed charges,35% of total billed charges for outpatient setting,398.58,78,,318.864,percent of total billed charges,78% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.13,83,,339.304,percent of total billed charges,83% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,200.14,39.17,,160.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,178.85,424.13,
OC INJ IM/SUBQ THERA PROPHYLACTIC,3040079,CDM,510,RC,96372,HCPCS,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.7,60.51,
INJECTION IM/SUBQ THERAPEUTIC,3040080,CDM,510,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM/SUBQ STEROID,3040081,CDM,510,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
INJECTION IM/SUBQ TRANQUALIZER,3040082,CDM,510,RC,96372,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,75.53,
OC IV PUSH THERAPUTIC PROPALACTIC,3040083,CDM,510,RC,96374,HCPCS,outpatient,,,402,201,,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,154.37,38.4,,123.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,154.37,38.4,,123.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.7,35,,112.56,percent of total billed charges,35% of total billed charges for outpatient setting,313.56,78,,250.848,percent of total billed charges,78% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,281.4,70,,225.12,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,301.5,75,,241.2,percent of total billed charges,75% of total billed charges for outpatient setting,333.66,83,,266.928,percent of total billed charges,83% of total billed charges for outpatient setting,201,50,,160.8,percent of total billed charges,50% of total billed charges for outpatient setting,201,50,,160.8,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.46,39.17,,125.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.7,333.66,
INJECTION IV THERAPUTIC,3040084,CDM,510,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
INJECTION IV TRANQUILIZER,3040085,CDM,510,RC,96374,HCPCS,outpatient,,,219,109.5,,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.1,38.4,,67.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,35,,61.32,percent of total billed charges,35% of total billed charges for outpatient setting,170.82,78,,136.656,percent of total billed charges,78% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,153.3,70,,122.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.25,75,,131.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.77,83,,145.416,percent of total billed charges,83% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.5,50,,87.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.78,39.17,,68.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.65,184.11,
CHEMO ADM SUBQ/IM,3040086,CDM,331,RC,96402,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO ADM INTRALESIONAL,3040087,CDM,335,RC,96405,HCPCS,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.85,424,
CHEMO ADM INTRALESIONAL MORE T,3040088,CDM,335,RC,96406,HCPCS,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.9,424,
OC CHEMO ADM IV PUSH EA ADDL SUBS,3040089,CDM,331,RC,96411,HCPCS,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,35,,41.72,percent of total billed charges,35% of total billed charges for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.36,39.17,,46.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,424,
OC CHEMO ADM IV INFU EA ADDL SUBS,3040090,CDM,335,RC,96417,HCPCS,outpatient,,,156,78,,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,59.9,38.4,,47.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.9,38.4,,47.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.6,35,,43.68,percent of total billed charges,35% of total billed charges for outpatient setting,121.68,78,,97.344,percent of total billed charges,78% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.2,70,,87.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117,75,,93.6,percent of total billed charges,75% of total billed charges for outpatient setting,129.48,83,,103.584,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.1,39.17,,48.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,54.6,424,
ESTABLISHED PAT LEVEL 3 W/REF,3040092,CDM,510,RC,99243,HCPCS,outpatient,,,243,121.5,,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.05,35,,68.04,percent of total billed charges,35% of total billed charges for outpatient setting,189.54,78,,151.632,percent of total billed charges,78% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.69,83,,161.352,percent of total billed charges,83% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.18,39.17,,76.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.05,201.69,
ESTABLISHED PAT LEVEL 4 W/REF,3040093,CDM,510,RC,99244,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
ESTABLISHED PAT LEVEL 5 W/REF,3040094,CDM,510,RC,99245,HCPCS,outpatient,,,483,241.5,,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.05,35,,135.24,percent of total billed charges,35% of total billed charges for outpatient setting,376.74,78,,301.392,percent of total billed charges,78% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,400.89,83,,320.712,percent of total billed charges,83% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.18,39.17,,151.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,169.05,400.89,
PREADMINISTRATION IV INFUSION,3040095,CDM,510,RC,,,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,77.5,50,,62,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,128.65,
ESTABLISHED PAT LEVEL 2 W/REF,3040096,CDM,500,RC,99242,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,60.55,143.59,
EEG,3210001,CDM,740,RC,95816,HCPCS,outpatient,,,859,429.5,,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.86,38.4,,263.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.65,35,,240.52,percent of total billed charges,35% of total billed charges for outpatient setting,670.02,78,,536.016,percent of total billed charges,78% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,601.3,70,,481.04,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,644.25,75,,515.4,percent of total billed charges,75% of total billed charges for outpatient setting,712.97,83,,570.376,percent of total billed charges,83% of total billed charges for outpatient setting,318,100,,,case rate,100% UHC case rate for outpatient setting,318,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.46,39.17,,269.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,712.97,
TREADMILL STRESS TEST,3210003,CDM,482,RC,93017,HCPCS,outpatient,,,2609.6,1304.8,,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1002.09,38.4,,801.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1002.09,38.4,,801.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,1957.2,75,,1565.76,percent of total billed charges,75% of total billed charges for outpatient setting,1957.2,75,,1565.76,percent of total billed charges,75% of total billed charges for outpatient setting,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,1957.2,75,,1565.76,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,913.36,35,,730.688,percent of total billed charges,35% of total billed charges for outpatient setting,2035.49,78,,1628.392,percent of total billed charges,78% of total billed charges for outpatient setting,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,1826.72,70,,1461.376,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1957.2,75,,1565.76,percent of total billed charges,75% of total billed charges for outpatient setting,2165.97,83,,1732.776,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1022.13,39.17,,817.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,2165.97,
CARDIOVERSION,3210040,CDM,480,RC,92960,HCPCS,outpatient,,,1363,681.5,,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,523.39,38.4,,418.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,523.39,38.4,,418.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,477.05,35,,381.64,percent of total billed charges,35% of total billed charges for outpatient setting,1063.14,78,,850.512,percent of total billed charges,78% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,1131.29,83,,905.032,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,533.86,39.17,,427.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424,1131.29,
ECHO TRANSTHORACIC,3210085,CDM,483,RC,93306,HCPCS,outpatient,,,2776.76,1388.38,,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1066.28,38.4,,853.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1066.28,38.4,,853.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,2082.57,75,,1666.056,percent of total billed charges,75% of total billed charges for outpatient setting,2082.57,75,,1666.056,percent of total billed charges,75% of total billed charges for outpatient setting,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,2082.57,75,,1666.056,percent of total billed charges,75% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,971.87,35,,777.496,percent of total billed charges,35% of total billed charges for outpatient setting,2165.87,78,,1732.696,percent of total billed charges,78% of total billed charges for outpatient setting,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,1943.73,70,,1554.984,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2082.57,75,,1666.056,percent of total billed charges,75% of total billed charges for outpatient setting,2304.71,83,,1843.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1087.61,39.17,,870.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424,2304.71,
TRACHEOSTOMY CARE,3210086,CDM,480,RC,31605,HCPCS,outpatient,,,842,421,,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,323.33,38.4,,258.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,294.7,35,,235.76,percent of total billed charges,35% of total billed charges for outpatient setting,656.76,78,,525.408,percent of total billed charges,78% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,589.4,70,,471.52,percent of total billed charges,70% of total billed charges for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,631.5,75,,505.2,percent of total billed charges,75% of total billed charges for outpatient setting,698.86,83,,559.088,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,329.8,39.17,,263.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,209.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,209.81,698.86,
EKG,3210100,CDM,730,RC,93005,HCPCS,outpatient,,,147.7,73.85,,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,56.72,38.4,,45.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.72,38.4,,45.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,110.78,75,,88.624,percent of total billed charges,75% of total billed charges for outpatient setting,110.78,75,,88.624,percent of total billed charges,75% of total billed charges for outpatient setting,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,110.78,75,,88.624,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,35,,41.36,percent of total billed charges,35% of total billed charges for outpatient setting,115.21,78,,92.168,percent of total billed charges,78% of total billed charges for outpatient setting,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,103.39,70,,82.712,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,110.78,75,,88.624,percent of total billed charges,75% of total billed charges for outpatient setting,122.59,83,,98.072,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.85,39.17,,46.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,424,
PACEMAKER,3210106,CDM,730,RC,,,outpatient,,,334,167,,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.26,38.4,,102.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.9,35,,93.52,percent of total billed charges,35% of total billed charges for outpatient setting,260.52,78,,208.416,percent of total billed charges,78% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,233.8,70,,187.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,250.5,75,,200.4,percent of total billed charges,75% of total billed charges for outpatient setting,277.22,83,,221.776,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.83,39.17,,104.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,116.9,424,
HOLTER MONITOR 24 HR,3210310,CDM,731,RC,93225,HCPCS,outpatient,,,638,319,,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,244.99,38.4,,195.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,244.99,38.4,,195.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,223.3,35,,178.64,percent of total billed charges,35% of total billed charges for outpatient setting,497.64,78,,398.112,percent of total billed charges,78% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,529.54,83,,423.632,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.89,39.17,,199.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,529.54,
HOLTER SCANNING,3210312,CDM,731,RC,93226,HCPCS,outpatient,,,893.2,446.6,,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,342.99,38.4,,274.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,342.99,38.4,,274.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,312.62,35,,250.096,percent of total billed charges,35% of total billed charges for outpatient setting,696.7,78,,557.36,percent of total billed charges,78% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,625.24,70,,500.192,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,669.9,75,,535.92,percent of total billed charges,75% of total billed charges for outpatient setting,741.36,83,,593.088,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,349.85,39.17,,279.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,741.36,
STRESS ECHO,3230015,CDM,480,RC,93350,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,265.78,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,473.87,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,265.78,1095.6,
EVENT MONITOR,3230016,CDM,731,RC,93271,HCPCS,outpatient,,,1407,703.5,,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,83.15,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,540.29,38.4,,432.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,540.29,38.4,,432.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,1055.25,75,,844.2,percent of total billed charges,75% of total billed charges for outpatient setting,1055.25,75,,844.2,percent of total billed charges,75% of total billed charges for outpatient setting,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,1055.25,75,,844.2,percent of total billed charges,75% of total billed charges for outpatient setting,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,492.45,35,,393.96,percent of total billed charges,35% of total billed charges for outpatient setting,1097.46,78,,877.968,percent of total billed charges,78% of total billed charges for outpatient setting,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,984.9,70,,787.92,percent of total billed charges,70% of total billed charges for outpatient setting,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1055.25,75,,844.2,percent of total billed charges,75% of total billed charges for outpatient setting,1167.81,83,,934.248,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.1,39.17,,440.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,83.15,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.15,1167.81,
NEW PT VISIT LEVEL 1,3400001,CDM,510,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
NEW PT VISIT LEVEL 2,3400002,CDM,510,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,106.24,
NEW PT VISIT LEVEL 3,3400003,CDM,510,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
NEW PT VISIT LEVEL 4,3400004,CDM,510,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEW PT VISIT LEVEL 5,3400005,CDM,510,RC,99205,HCPCS,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
PT VISIT LEVEL 1,3400006,CDM,510,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
PT VISIT LEVEL 2,3400007,CDM,510,RC,99212,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
PT VISIT LEVEL 3,3400008,CDM,510,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
PT VISIT LEVEL 4,3400009,CDM,510,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
PT VISIT LEVEL 5,3400010,CDM,510,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
CR INITIAL H&P CARD,3600003,CDM,480,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,424,
CR PHASE II CARDIAC EXERCISE,3600005,CDM,943,RC,93798,HCPCS,outpatient,,,522.2,261.1,,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,113.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,200.52,38.4,,160.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.52,38.4,,160.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,391.65,75,,313.32,percent of total billed charges,75% of total billed charges for outpatient setting,391.65,75,,313.32,percent of total billed charges,75% of total billed charges for outpatient setting,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,391.65,75,,313.32,percent of total billed charges,75% of total billed charges for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.77,35,,146.216,percent of total billed charges,35% of total billed charges for outpatient setting,407.32,78,,325.856,percent of total billed charges,78% of total billed charges for outpatient setting,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,365.54,70,,292.432,percent of total billed charges,70% of total billed charges for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,391.65,75,,313.32,percent of total billed charges,75% of total billed charges for outpatient setting,433.43,83,,346.744,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,204.53,39.17,,163.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.5,433.43,
CR PHASE III CARDIAC EXERCISE,3600013,CDM,943,RC,93797,HCPCS,outpatient,,,213,106.5,,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,113.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,81.79,38.4,,65.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.79,38.4,,65.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,159.75,75,,127.8,percent of total billed charges,75% of total billed charges for outpatient setting,159.75,75,,127.8,percent of total billed charges,75% of total billed charges for outpatient setting,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,159.75,75,,127.8,percent of total billed charges,75% of total billed charges for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.55,35,,59.64,percent of total billed charges,35% of total billed charges for outpatient setting,166.14,78,,132.912,percent of total billed charges,78% of total billed charges for outpatient setting,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,149.1,70,,119.28,percent of total billed charges,70% of total billed charges for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.75,75,,127.8,percent of total billed charges,75% of total billed charges for outpatient setting,176.79,83,,141.432,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.43,39.17,,66.744,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.55,424,
CR PHASE III PULMONARY,3600014,CDM,460,RC,,,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,424,
CR INITIAL EVALUATION PHASE III,3600015,CDM,510,RC,99201,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.8,73.04,
CR INITIAL EVALUATION PHASE III,3600016,CDM,460,RC,,,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.75,424,
CR PHASE III INTERIM SUMMARY (CAR,3600017,CDM,510,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
CR PHASE III INTERIM SUMMARY (PUL,3600018,CDM,460,RC,,,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.2,424,
CR CLINIC VISIT,3600020,CDM,510,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
CR EXERCISE FOR 15 MIN INTERVALS,3600022,CDM,943,RC,97110,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,424,
CR THERAPEUTIC PROC FOR ENDURANCE,3600023,CDM,419,RC,G0237,HCPCS,outpatient,,,114.8,57.4,,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,44.08,38.4,,35.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.08,38.4,,35.264,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,75,,68.88,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,75,,68.88,percent of total billed charges,75% of total billed charges for outpatient setting,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,75,,68.88,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.18,35,,32.144,percent of total billed charges,35% of total billed charges for outpatient setting,89.54,78,,71.632,percent of total billed charges,78% of total billed charges for outpatient setting,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,80.36,70,,64.288,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.1,75,,68.88,percent of total billed charges,75% of total billed charges for outpatient setting,95.28,83,,76.224,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.96,39.17,,35.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,212,
CR THERAPEUTIC PROC FOR RESPIRATORY,3600024,CDM,419,RC,G0238,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,25.57,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.57,212,
CHEST PA & LATERAL,4100000,CDM,980,RC,71020,HCPCS,outpatient,,,68,34,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ABDOMEN FLAT/KUB,4100001,CDM,980,RC,74000,HCPCS,outpatient,,,58,29,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"ABDOMEN, LAT & DEC",4100002,CDM,980,RC,74020,HCPCS,outpatient,,,91,45.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"ABDOMEN,UPRIGHT DEC",4100003,CDM,980,RC,74020,HCPCS,outpatient,,,91,45.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ABDOMINAL SERIES,4100004,CDM,980,RC,74022,HCPCS,outpatient,,,109,54.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ACROMIO-CLAVICULAR J BILATERAL,4100005,CDM,980,RC,73050,HCPCS,outpatient,,,86,43,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ADRENAL SCAN,4100007,CDM,980,RC,78075,HCPCS,outpatient,,,1086,543,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ANKLE 3 VIEWS LEFT,4100008,CDM,980,RC,73610,HCPCS,outpatient,,,77,38.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ANKLE 3 VIEWS RIGHT,4100009,CDM,980,RC,73610,HCPCS,outpatient,,,77,38.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
APICAL LORDOTIC,4100010,CDM,980,RC,71021,HCPCS,outpatient,,,83,41.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ARTHROGRAM LEFT SHOULDER,4100011,CDM,980,RC,73040,HCPCS,outpatient,,,240,120,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ARTHROGRAM RIGHT SHOULDER,4100012,CDM,980,RC,73040,HCPCS,outpatient,,,240,120,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BA-SWALLOW ESOPHAGRA,4100013,CDM,980,RC,74230,HCPCS,outpatient,,,305,152.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BARIUM ENEMA,4100014,CDM,980,RC,74270,HCPCS,outpatient,,,359,179.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BARIUM ENEMA W.AIR,4100015,CDM,980,RC,74280,HCPCS,outpatient,,,510,255,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BIOPSY CHEST,4100018,CDM,980,RC,77002,HCPCS,outpatient,,,224,112,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BONE LIMITED,4100025,CDM,980,RC,78300,HCPCS,outpatient,,,447,223.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BONE MULT AREAS,4100026,CDM,980,RC,78305,HCPCS,outpatient,,,572,286,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BONE SPECT,4100027,CDM,980,RC,78320,HCPCS,outpatient,,,564,282,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BONE WHOLE,4100028,CDM,980,RC,78306,HCPCS,outpatient,,,619,309.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BONE 3 PHRASE,4100029,CDM,980,RC,78315,HCPCS,outpatient,,,850,425,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
BREAST NEEDLE BIOSPY,4100030,CDM,980,RC,77032,HCPCS,outpatient,,,78,39,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
C-ARM EXAM,4100032,CDM,980,RC,76000,HCPCS,outpatient,,,114,57,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CAROTID DUPLEX DOPPL,4100033,CDM,980,RC,93880,HCPCS,outpatient,,,484,242,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CAROTID LIMITED,4100034,CDM,980,RC,93882,HCPCS,outpatient,,,309,154.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CERVICAL SP/OBL/FLEX,4100035,CDM,980,RC,72050,HCPCS,outpatient,,,110,55,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CERVICAL SPINE LIMIT,4100036,CDM,980,RC,72040,HCPCS,outpatient,,,80,40,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CERVICAL W FLEX-EXT,4100037,CDM,980,RC,72052,HCPCS,outpatient,,,135,67.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST APICAL LORDOTI,4100038,CDM,980,RC,71021,HCPCS,outpatient,,,83,41.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST FLUORO,4100039,CDM,980,RC,71034,HCPCS,outpatient,,,198,99,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST INDUSTRIAL,4100040,CDM,980,RC,71010,HCPCS,outpatient,,,55,27.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST LAT DECUB,4100041,CDM,980,RC,71035,HCPCS,outpatient,,,79,39.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST OBLIQUE,4100042,CDM,980,RC,71022,HCPCS,outpatient,,,100,50,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST PA,4100043,CDM,980,RC,71010,HCPCS,outpatient,,,55,27.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST W OBL/FLURO,4100044,CDM,980,RC,71030,HCPCS,outpatient,,,101,50.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHOLANGIOGRAPHY,4100045,CDM,980,RC,74300,HCPCS,outpatient,,,50,25,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CLAVICLE LEFT,4100046,CDM,980,RC,73000,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CLAVICLE RIGHT,4100047,CDM,980,RC,73000,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
COLOR DOPPLER,4100049,CDM,980,RC,93975,HCPCS,outpatient,,,674,337,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
COMPLETE DYNAMIC PHARYNGEAL &,4100050,CDM,980,RC,70371,HCPCS,outpatient,,,220,110,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ABDOMEN W/CONTRA,4100051,CDM,980,RC,74160,HCPCS,outpatient,,,554,277,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ABDOMEN W/O CONTR,4100052,CDM,980,RC,74150,HCPCS,outpatient,,,364,182,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ABDOMEN W-W/O CON,4100053,CDM,980,RC,74170,HCPCS,outpatient,,,4242,2121,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT BRAIN W-W/O CONTR,4100055,CDM,980,RC,70470,HCPCS,outpatient,,,463,231.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT BRAIN W/CONTRAST,4100056,CDM,980,RC,70460,HCPCS,outpatient,,,392,196,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT BRAIN W/O CONTRA,4100057,CDM,980,RC,70450,HCPCS,outpatient,,,281,140.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT CERVICAL SP W/CON,4100058,CDM,980,RC,72126,HCPCS,outpatient,,,548,274,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT CERVICAL SP 5-7 W/O CONTRAS,4100059,CDM,980,RC,72125,HCPCS,outpatient,,,444,222,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT CHEST W-W/O CONTR,4100060,CDM,980,RC,71270,HCPCS,outpatient,,,658,329,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT CHEST W/CONTRAST,4100061,CDM,980,RC,71260,HCPCS,outpatient,,,551,275.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT CHEST W/O CONTRA,4100062,CDM,980,RC,71250,HCPCS,outpatient,,,434,217,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT FACIAL W&WO CON,4100063,CDM,980,RC,70488,HCPCS,outpatient,,,492,246,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT FACIAL W/CON,4100064,CDM,980,RC,70487,HCPCS,outpatient,,,404,202,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT FACIAL W/O CON,4100065,CDM,980,RC,70486,HCPCS,outpatient,,,335,167.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT GUIDE CYST ASPIRA,4100067,CDM,980,RC,77012,HCPCS,outpatient,,,303,151.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT GUIDE NEEDLE BIOP,4100068,CDM,980,RC,77012,HCPCS,outpatient,,,303,151.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT L-SPINE W&WO CON,4100069,CDM,980,RC,72133,HCPCS,outpatient,,,645,322.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W&WO CO LEFT,4100070,CDM,980,RC,73702,HCPCS,outpatient,,,654,327,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W&WO CO RIGHT,4100071,CDM,980,RC,73702,HCPCS,outpatient,,,654,327,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W/CONT LEFT,4100072,CDM,980,RC,73701,HCPCS,outpatient,,,542,271,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W/CONT RIGHT,4100073,CDM,980,RC,73701,HCPCS,outpatient,,,542,271,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W/O CON LEFT,4100074,CDM,980,RC,73700,HCPCS,outpatient,,,432,216,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LOWER EXT W/O CON RIGHT,4100075,CDM,980,RC,73700,HCPCS,outpatient,,,432,216,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LUMBAR SPINE W/CO,4100076,CDM,980,RC,72132,HCPCS,outpatient,,,547,273.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT LUMBAR SPINE W/O CONTRAST,4100077,CDM,980,RC,72131,HCPCS,outpatient,,,432,216,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT NECK W&WO CON,4100078,CDM,980,RC,70492,HCPCS,outpatient,,,665,332.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT NECK W/CON,4100079,CDM,980,RC,70491,HCPCS,outpatient,,,566,283,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT NECK W/O CONTRAST,4100080,CDM,980,RC,70490,HCPCS,outpatient,,,466,233,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ORBIT W-WO/CONTR,4100081,CDM,980,RC,70482,HCPCS,outpatient,,,720,360,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ORBIT W/CONTR,4100082,CDM,980,RC,70481,HCPCS,outpatient,,,660,330,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT ORBIT W/O CONTR,4100083,CDM,980,RC,70480,HCPCS,outpatient,,,559,279.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT PELVIS W&WO CON,4100084,CDM,980,RC,72194,HCPCS,outpatient,,,622,311,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT PELVIS W/CONTRAST,4100085,CDM,980,RC,72193,HCPCS,outpatient,,,542,271,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT PELVIS W/O CONTRA,4100086,CDM,980,RC,72192,HCPCS,outpatient,,,354,177,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT T-SPINE W&WO CON,4100087,CDM,980,RC,72130,HCPCS,outpatient,,,648,324,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT TEMPORAL JOINT W&W/O CON,4100088,CDM,980,RC,70488,HCPCS,outpatient,,,492,246,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT TEMPORAL JOINT W/CON,4100089,CDM,980,RC,70487,HCPCS,outpatient,,,404,202,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT TEMPORAL W/O CON,4100090,CDM,980,RC,70486,HCPCS,outpatient,,,335,167.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT THORA-SPINE W/CON,4100091,CDM,980,RC,72129,HCPCS,outpatient,,,550,275,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT THORACIC SPINE W/O CONTRAST,4100092,CDM,980,RC,72128,HCPCS,outpatient,,,434,217,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT W&WO CONT LEFT,4100093,CDM,980,RC,73200,HCPCS,outpatient,,,432,216,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT W&WO CONT RIGHT,4100094,CDM,980,RC,73200,HCPCS,outpatient,,,432,216,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT W/CON LEFT,4100095,CDM,980,RC,73201,HCPCS,outpatient,,,534,267,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT W/CON RIGHT,4100096,CDM,980,RC,73201,HCPCS,outpatient,,,534,267,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT WO/CON LEFT,4100097,CDM,980,RC,73202,HCPCS,outpatient,,,661,330.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CT UPPER EXT WO/CON RIGHT,4100098,CDM,980,RC,73202,HCPCS,outpatient,,,661,330.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CYSTOURETHROGRAPHY,4100099,CDM,980,RC,74455,HCPCS,outpatient,,,196,98,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
DUAL BONE DENSITY ST,4100100,CDM,980,RC,77080,HCPCS,outpatient,,,99,49.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ELBOW 3 VIEWS LEFT,4100101,CDM,980,RC,73080,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ELBOW 3 VIEWS RIGHT,4100102,CDM,980,RC,73080,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FACIAL BONES,4100103,CDM,980,RC,70150,HCPCS,outpatient,,,100,50,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FEMUR LEFT,4100104,CDM,980,RC,73550,HCPCS,outpatient,,,24,12,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FEMUR RIGHT,4100105,CDM,980,RC,73550,HCPCS,outpatient,,,24,12,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FINGER/LEFT HAND 2ND DIGIT,4100106,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/LEFT HAND,THUMB",4100107,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/LEFT HAND,3RD DIGIT",4100108,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/LEFT HAND,4TH DIGIT",4100109,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/LEFT HAND,5TH DIGIT",4100110,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/RIGHT HAND,THUMB",4100111,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/RIGHT HAND,2ND DIGIT",4100112,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/RIGHT HAND,3RD DIGIT",4100113,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/RIGHT HAND,4TH DIGIT",4100114,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"FINGER/RIGHT HAND,5TH DIGIT",4100115,CDM,980,RC,73140,HCPCS,outpatient,,,76,38,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FLUORO OVER 1 HR,4100116,CDM,980,RC,76001,HCPCS,outpatient,,,92,46,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FOOT LEFT,4100117,CDM,980,RC,73630,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FOOT RIGHT,4100118,CDM,980,RC,73630,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FOREARM LEFT,4100119,CDM,980,RC,73090,HCPCS,outpatient,,,63,31.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
FOREARM RIGHT,4100120,CDM,980,RC,73090,HCPCS,outpatient,,,63,31.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
G I AIR EFF W/CONTRA,4100121,CDM,980,RC,74246,HCPCS,outpatient,,,339,169.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
G I BLEEDER,4100122,CDM,980,RC,78278,HCPCS,outpatient,,,857,428.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
G I SERIES,4100123,CDM,980,RC,74241,HCPCS,outpatient,,,282,141,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
G I W BARIUM SWALLOW,4100124,CDM,980,RC,74240,HCPCS,outpatient,,,271,135.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
GALLIUM ABCESS,4100126,CDM,980,RC,78806,HCPCS,outpatient,,,819,409.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
GALLIUM TUMOR SPECT,4100127,CDM,980,RC,78803,HCPCS,outpatient,,,840,420,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
GALLIUM WHOLE BODY,4100128,CDM,980,RC,78802,HCPCS,outpatient,,,795,397.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
GASTRIC EMPTYING SCA,4100129,CDM,980,RC,78264,HCPCS,outpatient,,,1961,980.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
GI TUBE PLACEMENT,4100130,CDM,980,RC,74340,HCPCS,outpatient,,,74,37,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HAND LEFT,4100131,CDM,980,RC,73130,HCPCS,outpatient,,,75,37.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HAND RIGHT,4100132,CDM,980,RC,73130,HCPCS,outpatient,,,75,37.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART MUGA,4100133,CDM,980,RC,78481,HCPCS,outpatient,,,433,216.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART MYO/CARD SPECT,4100134,CDM,980,RC,78469,HCPCS,outpatient,,,560,280,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART MYO/INFART,4100135,CDM,980,RC,78466,HCPCS,outpatient,,,481,240.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART PERFUSION,4100136,CDM,980,RC,78460,HCPCS,outpatient,,,117,58.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART PERFUSION THAL,4100137,CDM,980,RC,78461,HCPCS,outpatient,,,169,84.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HEART STRESS MUGA,4100138,CDM,980,RC,78483,HCPCS,outpatient,,,601,300.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIDA GALLBLADDER,4100139,CDM,980,RC,78223,HCPCS,outpatient,,,115,57.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIP AP LAT & PELVIS BILATERAL,4100140,CDM,980,RC,73520,HCPCS,outpatient,,,37,18.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIP AP UNILATERAL LEFT,4100141,CDM,980,RC,73510,HCPCS,outpatient,,,30,15,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIP AP UNILATERAL RIGHT,4100142,CDM,980,RC,73510,HCPCS,outpatient,,,30,15,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIP ARTHROGRAM LEFT,4100143,CDM,980,RC,73525,HCPCS,outpatient,,,244,122,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HIP ARTHROGRAM RIGHT,4100144,CDM,980,RC,73525,HCPCS,outpatient,,,244,122,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HUMERUS LEFT,4100146,CDM,980,RC,73060,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HUMERUS RIGHT,4100147,CDM,980,RC,73060,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
HYSTEROSALPINGO ATT,4100148,CDM,980,RC,74740,HCPCS,outpatient,,,180,90,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
I V P BOLUS/INF,4100149,CDM,980,RC,74410,HCPCS,outpatient,,,260,130,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
IVP HYPER STUDY,4100150,CDM,980,RC,74400,HCPCS,outpatient,,,264,132,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KIDNEY VASCULAR FLOW,4100151,CDM,980,RC,78707,HCPCS,outpatient,,,575,287.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE ARTHROGRAM LEFT,4100153,CDM,980,RC,73580,HCPCS,outpatient,,,272,136,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE ARTHROGRAM RIGHT,4100154,CDM,980,RC,73580,HCPCS,outpatient,,,272,136,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE COMP TUN/PAT LEFT,4100155,CDM,980,RC,73564,HCPCS,outpatient,,,96,48,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE COMP TUN/PAT RIGHT,4100156,CDM,980,RC,73564,HCPCS,outpatient,,,96,48,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE 3 VIEWS LEFT,4100157,CDM,980,RC,73562,HCPCS,outpatient,,,86,43,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
KNEE 3 VIEWS RIGHT,4100158,CDM,980,RC,73562,HCPCS,outpatient,,,86,43,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LIVER IMAGING,4100159,CDM,980,RC,78205,HCPCS,outpatient,,,520,260,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LIVER/SPLEEN,4100160,CDM,980,RC,78215,HCPCS,outpatient,,,477,238.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LIVER/SPLEN FLOW,4100161,CDM,980,RC,78216,HCPCS,outpatient,,,313,156.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LOWER EXT ART. UNIL. RIGHT,4100162,CDM,980,RC,93926,HCPCS,outpatient,,,363,181.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LOWER EXTRE-ARTERIAL BILATERAL,4100163,CDM,980,RC,93923,HCPCS,outpatient,,,329,164.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUMBOSACRAL SP INDUS,4100164,CDM,980,RC,72100,HCPCS,outpatient,,,85,42.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUMBOSACRAL SP W/OBL,4100165,CDM,980,RC,72110,HCPCS,outpatient,,,118,59,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUMBOSACRAL SPINE,4100166,CDM,980,RC,72100,HCPCS,outpatient,,,85,42.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUNG PERFUSION,4100167,CDM,980,RC,78580,HCPCS,outpatient,,,588,294,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUNG VENTILATION,4100168,CDM,980,RC,78586,HCPCS,outpatient,,,55,27.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LUNG VENTILATION MUL,4100169,CDM,980,RC,78587,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
LYMPHOSCINTIGRAM,4100170,CDM,980,RC,78195,HCPCS,outpatient,,,877,438.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MAMMOGRAM BILATERAL,4100171,CDM,980,RC,77056,HCPCS,outpatient,,,117,58.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MAMMOGRAM FOR WASH CO HEALTH D,4100172,CDM,980,RC,77057,HCPCS,outpatient,,,95,47.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MAMMOGRAM SCREENING BILATERAL,4100173,CDM,980,RC,77057,HCPCS,outpatient,,,95,47.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MAMMOGRAM UNILAT.LEFT,4100174,CDM,980,RC,77055,HCPCS,outpatient,,,95,47.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MAMMOGRAM UNILAT.RIGHT,4100175,CDM,980,RC,77055,HCPCS,outpatient,,,95,47.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MANDIBLE LESS 4 VIEW,4100176,CDM,980,RC,70100,HCPCS,outpatient,,,80,40,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"MANDIBLE, COMPLETE",4100177,CDM,980,RC,70110,HCPCS,outpatient,,,92,46,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MASTOIDS BILATERAL,4100178,CDM,980,RC,70130,HCPCS,outpatient,,,132,66,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MECKEL'S DIVERTICULU,4100179,CDM,980,RC,78290,HCPCS,outpatient,,,813,406.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA HEAD W/ & W/O CONTRAST,4100180,CDM,980,RC,70546,HCPCS,outpatient,,,1421,710.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA HEAD W/ CONTRAST,4100181,CDM,980,RC,70545,HCPCS,outpatient,,,922,461,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA HEAD W/O CONTRAST,4100182,CDM,980,RC,70544,HCPCS,outpatient,,,932,466,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA NECK W/ & W/O CONTRAST,4100183,CDM,980,RC,70549,HCPCS,outpatient,,,1429,714.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA NECK W/ CONTRAST,4100184,CDM,980,RC,70548,HCPCS,outpatient,,,980,490,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRA NECK W/O CONTRAST,4100185,CDM,980,RC,70547,HCPCS,outpatient,,,936,468,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ABD W/ & W/O CONTRAST,4100186,CDM,980,RC,74183,HCPCS,outpatient,,,1210,605,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ABD W/CONTRAST,4100187,CDM,980,RC,74182,HCPCS,outpatient,,,1083,541.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ANGIO C-SPINE W & W/0,4100188,CDM,980,RC,72156,HCPCS,outpatient,,,913,456.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ANGIO D-SPINE W & W/O CON,4100189,CDM,980,RC,72157,HCPCS,outpatient,,,915,457.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ANGIO L-SPINE W & W/O,4100190,CDM,980,RC,72158,HCPCS,outpatient,,,910,455,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI BRAIN W&W/O CONT,4100191,CDM,980,RC,70553,HCPCS,outpatient,,,908,454,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI BRAIN W/ CONTRST,4100192,CDM,980,RC,70552,HCPCS,outpatient,,,768,384,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI BRAIN W/O CONTRS,4100193,CDM,980,RC,70551,HCPCS,outpatient,,,556,278,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI C-SPINE W&W/O CO,4100194,CDM,980,RC,72156,HCPCS,outpatient,,,913,456.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI C-SPINE W/CONTR,4100195,CDM,980,RC,72142,HCPCS,outpatient,,,780,390,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI C-SPINE W/O CONT,4100196,CDM,980,RC,72141,HCPCS,outpatient,,,542,271,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI CHEST W&W/O CONT,4100197,CDM,980,RC,71552,HCPCS,outpatient,,,1380,690,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI CHEST W/CON,4100198,CDM,980,RC,71551,HCPCS,outpatient,,,1099,549.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI CHEST W/O CONT,4100199,CDM,980,RC,71550,HCPCS,outpatient,,,987,493.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI D-SPINE W&W/O CO,4100200,CDM,980,RC,72157,HCPCS,outpatient,,,915,457.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI D-SPINE W/CONTRA,4100201,CDM,980,RC,72147,HCPCS,outpatient,,,775,387.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI D-SPINE W/O CONT,4100202,CDM,980,RC,72146,HCPCS,outpatient,,,542,271,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI L-SPINE W&W/O CO,4100203,CDM,980,RC,72158,HCPCS,outpatient,,,910,455,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI L-SPINE W/CONTRA,4100204,CDM,980,RC,72149,HCPCS,outpatient,,,772,386,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI L-SPINE W/O CONT,4100205,CDM,980,RC,72148,HCPCS,outpatient,,,540,270,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT JOINT W&WO CONT LE,4100206,CDM,980,RC,73723,HCPCS,outpatient,,,1124,562,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT JOINT W&WO CONT RI,4100207,CDM,980,RC,73723,HCPCS,outpatient,,,1124,562,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT JOINT W/CON LEFT,4100208,CDM,980,RC,73722,HCPCS,outpatient,,,909,454.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT JOINT W/CON RIGHT,4100209,CDM,980,RC,73722,HCPCS,outpatient,,,909,454.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT NONJOINT W/CON LEF,4100210,CDM,980,RC,73719,HCPCS,outpatient,,,966,483,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT NONJOINT W/CON RIG,4100211,CDM,980,RC,73719,HCPCS,outpatient,,,966,483,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT NONJOINT W/O CONT,4100212,CDM,980,RC,73718,HCPCS,outpatient,,,868,434,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOW EXT NONJOINT W/O CONT,4100213,CDM,980,RC,73718,HCPCS,outpatient,,,868,434,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOWER EXT JOINT W/O CONT L,4100216,CDM,980,RC,73721,HCPCS,outpatient,,,570,285,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOWER EXT JOINT W/O CONT R,4100217,CDM,980,RC,73721,HCPCS,outpatient,,,570,285,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOWER EXT NON-JOINT W&WO C,4100218,CDM,980,RC,73720,HCPCS,outpatient,,,1198,599,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI LOWER EXT NON-JOINT W&WO C,4100219,CDM,980,RC,73720,HCPCS,outpatient,,,1198,599,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI ORBITS W/O CONTRAST,4100222,CDM,980,RC,70540,HCPCS,outpatient,,,722,361,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI TMJ,4100228,CDM,980,RC,70336,HCPCS,outpatient,,,769,384.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UP EXT NONJOINT W/O CONT L,4100229,CDM,980,RC,73218,HCPCS,outpatient,,,870,435,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UP EXT NONJOINT W/O CONT R,4100230,CDM,980,RC,73218,HCPCS,outpatient,,,870,435,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT JOINT W&WO CONT,4100231,CDM,980,RC,73223,HCPCS,outpatient,,,1123,561.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT JOINT W&WO CONT,4100232,CDM,980,RC,73223,HCPCS,outpatient,,,1123,561.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT JOINT W/CONT LEF,4100233,CDM,980,RC,73222,HCPCS,outpatient,,,902,451,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT JOINT W/CONT RIG,4100234,CDM,980,RC,73222,HCPCS,outpatient,,,902,451,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT NONJOINT W/CONT,4100235,CDM,980,RC,73219,HCPCS,outpatient,,,957,478.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT NONJOINT W/CONT,4100236,CDM,980,RC,73219,HCPCS,outpatient,,,957,478.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT W&WO NONJT LEFT,4100237,CDM,980,RC,73220,HCPCS,outpatient,,,1193,596.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER EXT W&WO NONJT RIGHT,4100238,CDM,980,RC,73220,HCPCS,outpatient,,,1193,596.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER JOINT W/O CONT LEFT,4100239,CDM,980,RC,73221,HCPCS,outpatient,,,570,285,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI UPPER JOINT W/O CONT RIGHT,4100240,CDM,980,RC,73221,HCPCS,outpatient,,,570,285,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MRI-ABDOMEN W/O CONTRAST,4100241,CDM,980,RC,74181,HCPCS,outpatient,,,794,397,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"MRI, ORBIT, FACE, AND NECK W&W",4100242,CDM,980,RC,70543,HCPCS,outpatient,,,998,499,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"MRI, ORBIT, FACE, AND NECK W/C",4100243,CDM,980,RC,70542,HCPCS,outpatient,,,811,405.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYELOGRAM C-SPINE,4100245,CDM,980,RC,72240,HCPCS,outpatient,,,240,120,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYELOGRAM THARACIC,4100247,CDM,980,RC,72255,HCPCS,outpatient,,,241,120.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYLOGRAM LUMBAR,4100248,CDM,980,RC,72265,HCPCS,outpatient,,,226,113,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYOCARDIAL PER/SPECT,4100249,CDM,980,RC,78465,HCPCS,outpatient,,,200,100,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYOCARDIAL PERFUSION,4100250,CDM,980,RC,78480,HCPCS,outpatient,,,86,43,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
MYOCARDIAL STUDY COMP,4100251,CDM,980,RC,78478,HCPCS,outpatient,,,86,43,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
NASAL BONES,4100252,CDM,980,RC,70160,HCPCS,outpatient,,,79,39.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
NEEDLE LOC BREAST LEFT,4100253,CDM,980,RC,77032,HCPCS,outpatient,,,78,39,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
NEEDLE LOC BREAST RIGHT,4100254,CDM,980,RC,77032,HCPCS,outpatient,,,78,39,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
NEPHROTOMOGRAPHY,4100256,CDM,980,RC,74415,HCPCS,outpatient,,,325,162.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ORBITS,4100257,CDM,980,RC,70200,HCPCS,outpatient,,,102,51,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
OS-CALCIS LEFT,4100258,CDM,980,RC,73650,HCPCS,outpatient,,,65,32.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
OS-CALCIS RIGHT,4100259,CDM,980,RC,73650,HCPCS,outpatient,,,65,32.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PARA THYROID,4100260,CDM,980,RC,78070,HCPCS,outpatient,,,737,368.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PARACENTESIS U/S GUIDE,4100261,CDM,980,RC,76942,HCPCS,outpatient,,,149,74.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PATELLA LEFT,4100262,CDM,980,RC,73564,HCPCS,outpatient,,,96,48,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PATELLA RIGHT,4100263,CDM,980,RC,73564,HCPCS,outpatient,,,96,48,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PELVIS,4100264,CDM,980,RC,73520,HCPCS,outpatient,,,37,18.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PELVIS AP,4100265,CDM,980,RC,72170,HCPCS,outpatient,,,77,38.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PHARYNX/LARYNX EXAM,4100266,CDM,980,RC,70370,HCPCS,outpatient,,,184,92,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"PHLEBOGRAM, BILATERAL",4100267,CDM,980,RC,75822,HCPCS,outpatient,,,333,166.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"PHLEBOGRAM, UNILATERAL",4100268,CDM,980,RC,75820,HCPCS,outpatient,,,278,139,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RETROGRADE UROGRAPHY,4100270,CDM,980,RC,74420,HCPCS,outpatient,,,50,25,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RIBS BIL/PA CHEST,4100271,CDM,980,RC,71111,HCPCS,outpatient,,,117,58.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RIBS BILATERAL,4100272,CDM,980,RC,71111,HCPCS,outpatient,,,117,58.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RIBS PA CHEST 3 VIEW,4100273,CDM,980,RC,71101,HCPCS,outpatient,,,89,44.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RIBS UNILATERAL,4100274,CDM,980,RC,71100,HCPCS,outpatient,,,80,40,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SACRO-ILIAC JOINT,4100275,CDM,980,RC,72202,HCPCS,outpatient,,,80,40,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SACROILIAC JOINTS EXAM LESS TH,4100276,CDM,980,RC,72200,HCPCS,outpatient,,,68,34,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SACRUM & COCCYX,4100277,CDM,980,RC,72220,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SCAPULA LEFT,4100278,CDM,980,RC,73010,HCPCS,outpatient,,,73,36.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SCAPULA RIGHT,4100279,CDM,980,RC,73010,HCPCS,outpatient,,,73,36.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SCOLIOSIS STUDY,4100280,CDM,980,RC,72090,HCPCS,outpatient,,,40,20,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SCROTAL SCAN,4100281,CDM,980,RC,78761,HCPCS,outpatient,,,525,262.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SEG ARTERIAL LOWER/BILATERAL,4100282,CDM,980,RC,93923,HCPCS,outpatient,,,329,164.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SEGMENTAL BP ARTERIA/STRESS BI,4100283,CDM,980,RC,93924,HCPCS,outpatient,,,409,204.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SEGMENTAL BP ARTERY BILATERAL,4100284,CDM,980,RC,93922,HCPCS,outpatient,,,211,105.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SENTINEL LYMPH NODE (BREAST),4100285,CDM,980,RC,78195,HCPCS,outpatient,,,877,438.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SHOULDER INT-EXT. LEFT,4100286,CDM,980,RC,73030,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SHOULDER INT-EXT. RIGHT,4100287,CDM,980,RC,73030,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"SINUSES, PARANASAL",4100288,CDM,980,RC,70220,HCPCS,outpatient,,,91,45.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SKELETAL SURVEY,4100289,CDM,980,RC,77075,HCPCS,outpatient,,,210,105,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SKULL 4 VIEWS,4100290,CDM,980,RC,70260,HCPCS,outpatient,,,111,55.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"SKULL, LIMITED STUDY",4100291,CDM,980,RC,70250,HCPCS,outpatient,,,88,44,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SMALL-BOWEL SERIES,4100292,CDM,980,RC,74250,HCPCS,outpatient,,,248,124,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SOFT TISSUE NECK,4100293,CDM,980,RC,70360,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO ABD (SPECIFY OR,4100294,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO ABD. FOLLOW-UP,4100295,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO ABD. LIVER,4100297,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO ABD.COMPLETE,4100298,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO ABD-BILIARY TR,4100299,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO AORTA,4100300,CDM,980,RC,76770,HCPCS,outpatient,,,275,137.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO PANCREAS,4100301,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO PELVIC GENERAL,4100302,CDM,980,RC,76856,HCPCS,outpatient,,,268,134,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO PELVIS OB(1,4100303,CDM,980,RC,76805,HCPCS,outpatient,,,347,173.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO RENAL,4100304,CDM,980,RC,76700,HCPCS,outpatient,,,297,148.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO RETROPERITONEUM,4100305,CDM,980,RC,76770,HCPCS,outpatient,,,275,137.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO TESTICLE,4100306,CDM,980,RC,76870,HCPCS,outpatient,,,168,84,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO THYROID,4100307,CDM,980,RC,76536,HCPCS,outpatient,,,280,140,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
STERNO-CLAVICULAR JT,4100308,CDM,980,RC,71130,HCPCS,outpatient,,,87,43.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
STERNUM,4100309,CDM,980,RC,71120,HCPCS,outpatient,,,71,35.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
T-TUBE CHOLANGIOGRAM,4100310,CDM,980,RC,74320,HCPCS,outpatient,,,74,37,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TEMPRO-MANDIBULAR JT BILATERAL,4100311,CDM,980,RC,70330,HCPCS,outpatient,,,116,58,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
THALLIUM SPECT,4100312,CDM,980,RC,78465,HCPCS,outpatient,,,200,100,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
THORACIC SPINE,4100313,CDM,980,RC,72072,HCPCS,outpatient,,,83,41.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
THYROID SCAN,4100314,CDM,980,RC,78010,HCPCS,outpatient,,,54,27,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
THYROID UPTAKE,4100315,CDM,980,RC,78000,HCPCS,outpatient,,,27,13.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
THYROIS SCAN/UPTAKE,4100316,CDM,980,RC,78006,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TIBIA & FIBULA AP-L LEFT,4100317,CDM,980,RC,73590,HCPCS,outpatient,,,69,34.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TIBIA & FIBULA AP-L RIGHT,4100318,CDM,980,RC,73590,HCPCS,outpatient,,,69,34.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TISSUE BIOPSY,4100319,CDM,980,RC,76098,HCPCS,outpatient,,,42,21,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TMJ UNIL LT,4100320,CDM,980,RC,70328,HCPCS,outpatient,,,74,37,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TMJ UNIL RT,4100321,CDM,980,RC,70328,HCPCS,outpatient,,,74,37,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/LEFT FOOT, GR",4100322,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/LEFT FOOT, 2N",4100323,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/LEFT FOOT, 3R",4100324,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/LEFT FOOT, 4T",4100325,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/LEFT FOOT, 5T",4100326,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/RIGHT FOOT, G",4100327,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/RIGHT FOOT, 2",4100328,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/RIGHT FOOT, 3",4100329,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/RIGHT FOOT, 4",4100330,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TOE AP-OBL & LAT/RIGHT FOOT, 5",4100331,CDM,980,RC,73660,HCPCS,outpatient,,,67,33.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TOMOGRAMS,4100332,CDM,980,RC,76100,HCPCS,outpatient,,,222,111,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TRANSRECTAL,4100333,CDM,980,RC,76872,HCPCS,outpatient,,,231,115.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
TRANSVAGINAL,4100334,CDM,980,RC,76830,HCPCS,outpatient,,,296,148,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
U/S LOWER EXT ART. UNIL. LEFT,4100335,CDM,980,RC,93926,HCPCS,outpatient,,,363,181.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
U/S SOFT TISSUE,4100336,CDM,980,RC,76536,HCPCS,outpatient,,,280,140,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
UPPER EXT ART. UNIL. LEFT,4100337,CDM,980,RC,93931,HCPCS,outpatient,,,308,154,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
UPPER EXT ART. UNIL. RIGHT,4100338,CDM,980,RC,93931,HCPCS,outpatient,,,308,154,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US ABD TRANSPLANT,4100339,CDM,980,RC,76778,HCPCS,outpatient,,,100,50,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US GUIDE CYST,4100344,CDM,980,RC,76942,HCPCS,outpatient,,,149,74.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US GUIDE NEEDLE BIOP,4100345,CDM,980,RC,76942,HCPCS,outpatient,,,149,74.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US GUIDE THORANCENTE,4100346,CDM,980,RC,76942,HCPCS,outpatient,,,149,74.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US HEAD AND NECK,4100347,CDM,980,RC,76536,HCPCS,outpatient,,,280,140,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US LOWER EXT ART BILATERAL,4100348,CDM,980,RC,93925,HCPCS,outpatient,,,617,308.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
US UPPER EXT BIL,4100349,CDM,980,RC,93930,HCPCS,outpatient,,,498,249,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER BIL LOWER,4100350,CDM,980,RC,93970,HCPCS,outpatient,,,471,235.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER BIL UPPER,4100351,CDM,980,RC,93970,HCPCS,outpatient,,,471,235.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER UNIL LEFT LOWER,4100352,CDM,980,RC,93971,HCPCS,outpatient,,,288,144,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER UNIL LEFT UPPER,4100353,CDM,980,RC,93971,HCPCS,outpatient,,,288,144,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER UNIL RIGHT LOWE,4100354,CDM,980,RC,93971,HCPCS,outpatient,,,288,144,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS DOPPLER UNIL RIGHT UPPE,4100355,CDM,980,RC,93971,HCPCS,outpatient,,,288,144,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENOUS/ARTERIAL DOPPLER,4100356,CDM,980,RC,93978,HCPCS,outpatient,,,457,228.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST AP/LAT LEFT,4100357,CDM,980,RC,73100,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST AP/LAT RIGHT,4100358,CDM,980,RC,73100,HCPCS,outpatient,,,70,35,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST ARTHOGRAM LEFT,4100359,CDM,980,RC,73115,HCPCS,outpatient,,,255,127.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST ARTHOGRAM RIGHT,4100360,CDM,980,RC,73115,HCPCS,outpatient,,,255,127.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST W OBLIQUES LEFT,4100361,CDM,980,RC,73110,HCPCS,outpatient,,,85,42.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
WRIST W OBLIQUES RIGHT,4100362,CDM,980,RC,73110,HCPCS,outpatient,,,85,42.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SONO PELVIS COMPLETE,4100364,CDM,980,RC,76810,HCPCS,outpatient,,,231,115.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"DEBRIDE SKIN, SUBCUT, MUSCLE",4400000,CDM,360,RC,11011,HCPCS,outpatient,,,1059,529.5,,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,406.66,38.4,,325.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,35,,296.52,percent of total billed charges,35% of total billed charges for outpatient setting,826.02,78,,660.816,percent of total billed charges,78% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,741.3,70,,593.04,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.25,75,,635.4,percent of total billed charges,75% of total billed charges for outpatient setting,878.97,83,,703.176,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,414.79,39.17,,331.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,370.65,1452,
"DEBRD MUSCLE,FASC,SUBCUT 20SQ",4400001,CDM,360,RC,11043,HCPCS,outpatient,,,422,211,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,35,,118.16,percent of total billed charges,35% of total billed charges for outpatient setting,329.16,78,,263.328,percent of total billed charges,78% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,350.26,83,,280.208,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165.29,39.17,,132.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,659,
ACULSION OF NAIL PLATE PART/CO,4400002,CDM,360,RC,11730,HCPCS,outpatient,,,257,128.5,,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.95,35,,71.96,percent of total billed charges,35% of total billed charges for outpatient setting,200.46,78,,160.368,percent of total billed charges,78% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,213.31,83,,170.648,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.66,39.17,,80.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.95,659,
ASPIR OR INJECT MARJOR JOINT,4400003,CDM,521,RC,20610,HCPCS,outpatient,,,401,200.5,,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,153.98,38.4,,123.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.98,38.4,,123.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,300.75,75,,240.6,percent of total billed charges,75% of total billed charges for outpatient setting,300.75,75,,240.6,percent of total billed charges,75% of total billed charges for outpatient setting,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,300.75,75,,240.6,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.35,35,,112.28,percent of total billed charges,35% of total billed charges for outpatient setting,312.78,78,,250.224,percent of total billed charges,78% of total billed charges for outpatient setting,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,280.7,70,,224.56,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,300.75,75,,240.6,percent of total billed charges,75% of total billed charges for outpatient setting,332.83,83,,266.264,percent of total billed charges,83% of total billed charges for outpatient setting,200.5,50,,160.4,percent of total billed charges,50% of total billed charges for outpatient setting,200.5,50,,160.4,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.06,39.17,,125.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.35,332.83,
REMOVAL IMPLANT DEEP,4400004,CDM,360,RC,20680,HCPCS,outpatient,,,2632,1316,,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1010.69,38.4,,808.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1010.69,38.4,,808.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.2,35,,736.96,percent of total billed charges,35% of total billed charges for outpatient setting,2052.96,78,,1642.368,percent of total billed charges,78% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,2184.56,83,,1747.648,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1030.9,39.17,,824.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.2,3141,
REPAIR OF RUPTURED ROTATOR CUF,4400005,CDM,360,RC,23410,HCPCS,outpatient,,,2632,1316,,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1010.69,38.4,,808.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1010.69,38.4,,808.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.2,35,,736.96,percent of total billed charges,35% of total billed charges for outpatient setting,2052.96,78,,1642.368,percent of total billed charges,78% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,1842.4,70,,1473.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1974,75,,1579.2,percent of total billed charges,75% of total billed charges for outpatient setting,2184.56,83,,1747.648,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1030.9,39.17,,824.72,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.2,6145.19,
RECONS OR COMP ROTATOR CUFF AV,4400006,CDM,360,RC,23420,HCPCS,outpatient,,,3157,1578.5,,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1212.29,38.4,,969.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1212.29,38.4,,969.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,2367.75,75,,1894.2,percent of total billed charges,75% of total billed charges for outpatient setting,2367.75,75,,1894.2,percent of total billed charges,75% of total billed charges for outpatient setting,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,2367.75,75,,1894.2,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1104.95,35,,883.96,percent of total billed charges,35% of total billed charges for outpatient setting,2462.46,78,,1969.968,percent of total billed charges,78% of total billed charges for outpatient setting,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,2209.9,70,,1767.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2367.75,75,,1894.2,percent of total billed charges,75% of total billed charges for outpatient setting,2620.31,83,,2096.248,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1236.54,39.17,,989.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1104.95,6145.19,
INCISION EXTEN TENDON SHEAT WR,4400007,CDM,360,RC,25111,HCPCS,outpatient,,,2532,1266,,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,972.29,38.4,,777.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,972.29,38.4,,777.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,886.2,35,,708.96,percent of total billed charges,35% of total billed charges for outpatient setting,1974.96,78,,1579.968,percent of total billed charges,78% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1772.4,70,,1417.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1899,75,,1519.2,percent of total billed charges,75% of total billed charges for outpatient setting,2101.56,83,,1681.248,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,991.74,39.17,,793.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,886.2,3141,
CLOSED TREAT DIST RAD FX W/MAN,4400008,CDM,360,RC,25605,HCPCS,outpatient,,,2384,1192,,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,915.46,38.4,,732.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.46,38.4,,732.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1788,75,,1430.4,percent of total billed charges,75% of total billed charges for outpatient setting,1788,75,,1430.4,percent of total billed charges,75% of total billed charges for outpatient setting,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1788,75,,1430.4,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.4,35,,667.52,percent of total billed charges,35% of total billed charges for outpatient setting,1859.52,78,,1487.616,percent of total billed charges,78% of total billed charges for outpatient setting,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1668.8,70,,1335.04,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1788,75,,1430.4,percent of total billed charges,75% of total billed charges for outpatient setting,1978.72,83,,1582.976,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,933.77,39.17,,747.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.4,1978.72,
TENDON SHEATH INCIS (TRIGGER F,4400009,CDM,360,RC,26055,HCPCS,outpatient,,,1355,677.5,,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,520.32,38.4,,416.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,520.32,38.4,,416.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,1016.25,75,,813,percent of total billed charges,75% of total billed charges for outpatient setting,1016.25,75,,813,percent of total billed charges,75% of total billed charges for outpatient setting,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,1016.25,75,,813,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,474.25,35,,379.4,percent of total billed charges,35% of total billed charges for outpatient setting,1056.9,78,,845.52,percent of total billed charges,78% of total billed charges for outpatient setting,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,948.5,70,,758.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1016.25,75,,813,percent of total billed charges,75% of total billed charges for outpatient setting,1124.65,83,,899.72,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,530.73,39.17,,424.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,474.25,2175,
EXCISION BAKERS CYST KNEE,4400010,CDM,360,RC,27345,HCPCS,outpatient,,,1689,844.5,,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,648.58,38.4,,518.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,648.58,38.4,,518.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.15,35,,472.92,percent of total billed charges,35% of total billed charges for outpatient setting,1317.42,78,,1053.936,percent of total billed charges,78% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1401.87,83,,1121.496,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,661.55,39.17,,529.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.15,3141,
OPEN TREAT BIMALLEOLAR ANKLE F,4400011,CDM,360,RC,27814,HCPCS,outpatient,,,5411,2705.5,,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,2077.82,38.4,,1662.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2077.82,38.4,,1662.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,4058.25,75,,3246.6,percent of total billed charges,75% of total billed charges for outpatient setting,4058.25,75,,3246.6,percent of total billed charges,75% of total billed charges for outpatient setting,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,4058.25,75,,3246.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1893.85,35,,1515.08,percent of total billed charges,35% of total billed charges for outpatient setting,4220.58,78,,3376.464,percent of total billed charges,78% of total billed charges for outpatient setting,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,3787.7,70,,3030.16,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,4058.25,75,,3246.6,percent of total billed charges,75% of total billed charges for outpatient setting,4491.13,83,,3592.904,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2119.38,39.17,,1695.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1893.85,6145.19,
OPEN TREAT TRIMALLEOLAR ANKLE,4400012,CDM,360,RC,27822,HCPCS,outpatient,,,2464,1232,,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,946.18,38.4,,756.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,946.18,38.4,,756.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,1848,75,,1478.4,percent of total billed charges,75% of total billed charges for outpatient setting,1848,75,,1478.4,percent of total billed charges,75% of total billed charges for outpatient setting,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,1848,75,,1478.4,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,862.4,35,,689.92,percent of total billed charges,35% of total billed charges for outpatient setting,1921.92,78,,1537.536,percent of total billed charges,78% of total billed charges for outpatient setting,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,1724.8,70,,1379.84,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1848,75,,1478.4,percent of total billed charges,75% of total billed charges for outpatient setting,2045.12,83,,1636.096,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,965.1,39.17,,772.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,862.4,6145.19,
CLOSED TREAT DIST TIBIA FX W/O,4400013,CDM,360,RC,27824,HCPCS,outpatient,,,928,464,,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,356.35,38.4,,285.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,356.35,38.4,,285.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,696,75,,556.8,percent of total billed charges,75% of total billed charges for outpatient setting,696,75,,556.8,percent of total billed charges,75% of total billed charges for outpatient setting,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,696,75,,556.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,324.8,35,,259.84,percent of total billed charges,35% of total billed charges for outpatient setting,723.84,78,,579.072,percent of total billed charges,78% of total billed charges for outpatient setting,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,649.6,70,,519.68,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,696,75,,556.8,percent of total billed charges,75% of total billed charges for outpatient setting,770.24,83,,616.192,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,363.48,39.17,,290.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,770.24,
OPEN TREAT LAT MALLEOULUS FX 1,4400014,CDM,360,RC,27792,HCPCS,outpatient,,,1871,935.5,,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,718.46,38.4,,574.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,718.46,38.4,,574.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,1403.25,75,,1122.6,percent of total billed charges,75% of total billed charges for outpatient setting,1403.25,75,,1122.6,percent of total billed charges,75% of total billed charges for outpatient setting,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,1403.25,75,,1122.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,654.85,35,,523.88,percent of total billed charges,35% of total billed charges for outpatient setting,1459.38,78,,1167.504,percent of total billed charges,78% of total billed charges for outpatient setting,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,1309.7,70,,1047.76,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1403.25,75,,1122.6,percent of total billed charges,75% of total billed charges for outpatient setting,1552.93,83,,1242.344,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,732.83,39.17,,586.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,654.85,6145.19,
EXCIS BONE CYST TARSAL OR META,4400015,CDM,360,RC,28104,HCPCS,outpatient,,,2421,1210.5,,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,929.66,38.4,,743.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,929.66,38.4,,743.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,1815.75,75,,1452.6,percent of total billed charges,75% of total billed charges for outpatient setting,1815.75,75,,1452.6,percent of total billed charges,75% of total billed charges for outpatient setting,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,1815.75,75,,1452.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,847.35,35,,677.88,percent of total billed charges,35% of total billed charges for outpatient setting,1888.38,78,,1510.704,percent of total billed charges,78% of total billed charges for outpatient setting,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,1694.7,70,,1355.76,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1815.75,75,,1452.6,percent of total billed charges,75% of total billed charges for outpatient setting,2009.43,83,,1607.544,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,948.25,39.17,,758.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,847.35,3141,
TENOTOMY OPEN EXTENSOR FOOT OR,4400016,CDM,360,RC,28234,HCPCS,outpatient,,,1569,784.5,,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,602.5,38.4,,482,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,602.5,38.4,,482,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1176.75,75,,941.4,percent of total billed charges,75% of total billed charges for outpatient setting,1176.75,75,,941.4,percent of total billed charges,75% of total billed charges for outpatient setting,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1176.75,75,,941.4,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,549.15,35,,439.32,percent of total billed charges,35% of total billed charges for outpatient setting,1223.82,78,,979.056,percent of total billed charges,78% of total billed charges for outpatient setting,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1098.3,70,,878.64,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1176.75,75,,941.4,percent of total billed charges,75% of total billed charges for outpatient setting,1302.27,83,,1041.816,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,614.55,39.17,,491.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,549.15,3141,
HALLUS RIGIDUS CORRECT W/ CHEI,4400017,CDM,360,RC,28289,HCPCS,outpatient,,,1687,843.5,,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,647.81,38.4,,518.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,647.81,38.4,,518.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,1265.25,75,,1012.2,percent of total billed charges,75% of total billed charges for outpatient setting,1265.25,75,,1012.2,percent of total billed charges,75% of total billed charges for outpatient setting,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,1265.25,75,,1012.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,590.45,35,,472.36,percent of total billed charges,35% of total billed charges for outpatient setting,1315.86,78,,1052.688,percent of total billed charges,78% of total billed charges for outpatient setting,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,1180.9,70,,944.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1265.25,75,,1012.2,percent of total billed charges,75% of total billed charges for outpatient setting,1400.21,83,,1120.168,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,660.77,39.17,,528.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,590.45,3141,
OSTEOMY OTHER THAN FIRST METAT,4400018,CDM,360,RC,28308,HCPCS,outpatient,,,1084,542,,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,416.26,38.4,,333.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,416.26,38.4,,333.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,813,75,,650.4,percent of total billed charges,75% of total billed charges for outpatient setting,813,75,,650.4,percent of total billed charges,75% of total billed charges for outpatient setting,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,813,75,,650.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,379.4,35,,303.52,percent of total billed charges,35% of total billed charges for outpatient setting,845.52,78,,676.416,percent of total billed charges,78% of total billed charges for outpatient setting,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,758.8,70,,607.04,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,813,75,,650.4,percent of total billed charges,75% of total billed charges for outpatient setting,899.72,83,,719.776,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424.59,39.17,,339.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,379.4,3141,
LONG ARM CAST,4400019,CDM,360,RC,29065,HCPCS,outpatient,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.1,659,
ARTHO KNEE W/ MED OR LAT CHOND,4400020,CDM,360,RC,29881,HCPCS,outpatient,,,2633,1316.5,,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1011.07,38.4,,808.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1011.07,38.4,,808.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,1974.75,75,,1579.8,percent of total billed charges,75% of total billed charges for outpatient setting,1974.75,75,,1579.8,percent of total billed charges,75% of total billed charges for outpatient setting,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,1974.75,75,,1579.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.55,35,,737.24,percent of total billed charges,35% of total billed charges for outpatient setting,2053.74,78,,1642.992,percent of total billed charges,78% of total billed charges for outpatient setting,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,1843.1,70,,1474.48,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1974.75,75,,1579.8,percent of total billed charges,75% of total billed charges for outpatient setting,2185.39,83,,1748.312,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1031.29,39.17,,825.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,921.55,3868,
XRAY WRIST 2 VIEWS,4400021,CDM,360,RC,73100,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,78.05,
XRAY WRIST 2 VIEWS,4400022,CDM,360,RC,73100,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,44.05,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,35,50,,28,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,78.05,
XRAY CALCANEUS 2 VIEWS,4400023,CDM,360,RC,73650,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,40.5,50,,32.4,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,78.05,
XRAY CALCANEUS 2 VIEWS,4400024,CDM,360,RC,73650,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,37.18,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,78.05,
FLOURO GUIDANCE NEEDLE PLACEME,4400025,CDM,360,RC,77002,HCPCS,outpatient,,,224,112,,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,128.43,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.4,35,,62.72,percent of total billed charges,35% of total billed charges for outpatient setting,174.72,78,,139.776,percent of total billed charges,78% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,185.92,83,,148.736,percent of total billed charges,83% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,112,50,,89.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.74,39.17,,70.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.4,185.92,
CARPAL TUNNEL RELEASE,4400026,CDM,360,RC,64721,HCPCS,outpatient,,,3027,1513.5,,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,1658.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1162.37,38.4,,929.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1162.37,38.4,,929.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,2270.25,75,,1816.2,percent of total billed charges,75% of total billed charges for outpatient setting,2270.25,75,,1816.2,percent of total billed charges,75% of total billed charges for outpatient setting,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,2270.25,75,,1816.2,percent of total billed charges,75% of total billed charges for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1059.45,35,,847.56,percent of total billed charges,35% of total billed charges for outpatient setting,2361.06,78,,1888.848,percent of total billed charges,78% of total billed charges for outpatient setting,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,2118.9,70,,1695.12,percent of total billed charges,70% of total billed charges for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2270.25,75,,1816.2,percent of total billed charges,75% of total billed charges for outpatient setting,2512.41,83,,2009.928,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1185.62,39.17,,948.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1059.45,3141,
ARTHO KNEE W/ MED OR LAT MENIS,4400028,CDM,360,RC,29882,HCPCS,outpatient,,,3001,1500.5,,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1152.38,38.4,,921.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1152.38,38.4,,921.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2250.75,75,,1800.6,percent of total billed charges,75% of total billed charges for outpatient setting,2250.75,75,,1800.6,percent of total billed charges,75% of total billed charges for outpatient setting,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2250.75,75,,1800.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1050.35,35,,840.28,percent of total billed charges,35% of total billed charges for outpatient setting,2340.78,78,,1872.624,percent of total billed charges,78% of total billed charges for outpatient setting,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2100.7,70,,1680.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2250.75,75,,1800.6,percent of total billed charges,75% of total billed charges for outpatient setting,2490.83,83,,1992.664,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1175.43,39.17,,940.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1050.35,3868,
SYNOVECTOMY KNEE LIMITED PLICA,4400029,CDM,360,RC,29875,HCPCS,outpatient,,,2237,1118.5,,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,859.01,38.4,,687.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,859.01,38.4,,687.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,1677.75,75,,1342.2,percent of total billed charges,75% of total billed charges for outpatient setting,1677.75,75,,1342.2,percent of total billed charges,75% of total billed charges for outpatient setting,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,1677.75,75,,1342.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.95,35,,626.36,percent of total billed charges,35% of total billed charges for outpatient setting,1744.86,78,,1395.888,percent of total billed charges,78% of total billed charges for outpatient setting,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,1565.9,70,,1252.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1677.75,75,,1342.2,percent of total billed charges,75% of total billed charges for outpatient setting,1856.71,83,,1485.368,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,876.19,39.17,,700.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,782.95,3868,
OPERN TREAT PATELLAR FX W/ INT,4400030,CDM,360,RC,27524,HCPCS,outpatient,,,2388,1194,,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,916.99,38.4,,733.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,916.99,38.4,,733.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,1791,75,,1432.8,percent of total billed charges,75% of total billed charges for outpatient setting,1791,75,,1432.8,percent of total billed charges,75% of total billed charges for outpatient setting,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,1791,75,,1432.8,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,835.8,35,,668.64,percent of total billed charges,35% of total billed charges for outpatient setting,1862.64,78,,1490.112,percent of total billed charges,78% of total billed charges for outpatient setting,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,1671.6,70,,1337.28,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1791,75,,1432.8,percent of total billed charges,75% of total billed charges for outpatient setting,1982.04,83,,1585.632,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,935.33,39.17,,748.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,835.8,6145.19,
DISARTICULATION AT THE KNEE,4400031,CDM,360,RC,27598,HCPCS,outpatient,,,2446,1223,,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,2446,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,939.26,38.4,,751.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,939.26,38.4,,751.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,1834.5,75,,1467.6,percent of total billed charges,75% of total billed charges for outpatient setting,1834.5,75,,1467.6,percent of total billed charges,75% of total billed charges for outpatient setting,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,1834.5,75,,1467.6,percent of total billed charges,75% of total billed charges for outpatient setting,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,856.1,35,,684.88,percent of total billed charges,35% of total billed charges for outpatient setting,1907.88,78,,1526.304,percent of total billed charges,78% of total billed charges for outpatient setting,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,1712.2,70,,1369.76,percent of total billed charges,70% of total billed charges for outpatient setting,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1834.5,75,,1467.6,percent of total billed charges,75% of total billed charges for outpatient setting,2030.18,83,,1624.144,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,958.05,39.17,,766.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2446,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,856.1,5560,
ARTHO KNEE W MED/LAT MENISCECT,4400032,CDM,360,RC,29880,HCPCS,outpatient,,,5207,2603.5,,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,35,,1457.96,percent of total billed charges,35% of total billed charges for outpatient setting,4061.46,78,,3249.168,percent of total billed charges,78% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,4321.81,83,,3457.448,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2039.48,39.17,,1631.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,4321.81,
SYNOVECTOMY KNEE MAJOR 2 OR MO,4400033,CDM,360,RC,29876,HCPCS,outpatient,,,5207,2603.5,,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,35,,1457.96,percent of total billed charges,35% of total billed charges for outpatient setting,4061.46,78,,3249.168,percent of total billed charges,78% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,4321.81,83,,3457.448,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2039.48,39.17,,1631.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,4321.81,
EXC BENIGN LESI T A L 1.1 TO 2,4400034,CDM,360,RC,11402,HCPCS,outpatient,,,288,144,,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.59,38.4,,88.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,35,,80.64,percent of total billed charges,35% of total billed charges for outpatient setting,224.64,78,,179.712,percent of total billed charges,78% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,201.6,70,,161.28,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,216,75,,172.8,percent of total billed charges,75% of total billed charges for outpatient setting,239.04,83,,191.232,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,112.8,39.17,,90.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.8,1452,
EXC BENIGN LESI T A L 2.1 TO 3,4400035,CDM,360,RC,11403,HCPCS,outpatient,,,371,185.5,,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,142.46,38.4,,113.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.46,38.4,,113.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,278.25,75,,222.6,percent of total billed charges,75% of total billed charges for outpatient setting,278.25,75,,222.6,percent of total billed charges,75% of total billed charges for outpatient setting,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,278.25,75,,222.6,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.85,35,,103.88,percent of total billed charges,35% of total billed charges for outpatient setting,289.38,78,,231.504,percent of total billed charges,78% of total billed charges for outpatient setting,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,259.7,70,,207.76,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,278.25,75,,222.6,percent of total billed charges,75% of total billed charges for outpatient setting,307.93,83,,246.344,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.31,39.17,,116.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.85,1452,
EXC BENIGN LESION SNHFG .6-1CM,4400036,CDM,360,RC,11421,HCPCS,outpatient,,,278,139,,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,35,,77.84,percent of total billed charges,35% of total billed charges for outpatient setting,216.84,78,,173.472,percent of total billed charges,78% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,230.74,83,,184.592,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.89,39.17,,87.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,1452,
EXC BENIGN LESION SNHFG 2.1-3C,4400037,CDM,360,RC,11423,HCPCS,outpatient,,,405,202.5,,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,155.52,38.4,,124.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.52,38.4,,124.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.75,35,,113.4,percent of total billed charges,35% of total billed charges for outpatient setting,315.9,78,,252.72,percent of total billed charges,78% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,283.5,70,,226.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,303.75,75,,243,percent of total billed charges,75% of total billed charges for outpatient setting,336.15,83,,268.92,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.63,39.17,,126.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.75,2175,
EXC BENIGN LESION SNHFG 3.1-4C,4400038,CDM,360,RC,11424,HCPCS,outpatient,,,487,243.5,,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,187.01,38.4,,149.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.01,38.4,,149.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.45,35,,136.36,percent of total billed charges,35% of total billed charges for outpatient setting,379.86,78,,303.888,percent of total billed charges,78% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,340.9,70,,272.72,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.25,75,,292.2,percent of total billed charges,75% of total billed charges for outpatient setting,404.21,83,,323.368,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,190.75,39.17,,152.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,170.45,2175,
EXC TUM S/T OF SHLDR INTRM5CM>,4400039,CDM,360,RC,23073,HCPCS,outpatient,,,1825,912.5,,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,700.8,38.4,,560.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,700.8,38.4,,560.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,1368.75,75,,1095,percent of total billed charges,75% of total billed charges for outpatient setting,1368.75,75,,1095,percent of total billed charges,75% of total billed charges for outpatient setting,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,1368.75,75,,1095,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,638.75,35,,511,percent of total billed charges,35% of total billed charges for outpatient setting,1423.5,78,,1138.8,percent of total billed charges,78% of total billed charges for outpatient setting,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,1277.5,70,,1022,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1368.75,75,,1095,percent of total billed charges,75% of total billed charges for outpatient setting,1514.75,83,,1211.8,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,714.82,39.17,,571.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,638.75,3141,
ACROMIOPLASTY W/WO CORACOACR L,4400040,CDM,360,RC,23130,HCPCS,outpatient,,,1887,943.5,,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,724.61,38.4,,579.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,724.61,38.4,,579.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,1415.25,75,,1132.2,percent of total billed charges,75% of total billed charges for outpatient setting,1415.25,75,,1132.2,percent of total billed charges,75% of total billed charges for outpatient setting,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,1415.25,75,,1132.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,660.45,35,,528.36,percent of total billed charges,35% of total billed charges for outpatient setting,1471.86,78,,1177.488,percent of total billed charges,78% of total billed charges for outpatient setting,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,1320.9,70,,1056.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1415.25,75,,1132.2,percent of total billed charges,75% of total billed charges for outpatient setting,1566.21,83,,1252.968,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,739.1,39.17,,591.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,660.45,4833,
TENOTOMY (TENNIS ELBOW),4400041,CDM,360,RC,24357,HCPCS,outpatient,,,1462,731,,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,561.41,38.4,,449.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,561.41,38.4,,449.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,1096.5,75,,877.2,percent of total billed charges,75% of total billed charges for outpatient setting,1096.5,75,,877.2,percent of total billed charges,75% of total billed charges for outpatient setting,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,1096.5,75,,877.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,511.7,35,,409.36,percent of total billed charges,35% of total billed charges for outpatient setting,1140.36,78,,912.288,percent of total billed charges,78% of total billed charges for outpatient setting,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,1023.4,70,,818.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1096.5,75,,877.2,percent of total billed charges,75% of total billed charges for outpatient setting,1213.46,83,,970.768,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,572.64,39.17,,458.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,511.7,3141,
INCISION EXTENS TENDON SHEAT W,4400042,CDM,360,RC,25000,HCPCS,outpatient,,,2455,1227.5,,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,942.72,38.4,,754.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,942.72,38.4,,754.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1841.25,75,,1473,percent of total billed charges,75% of total billed charges for outpatient setting,1841.25,75,,1473,percent of total billed charges,75% of total billed charges for outpatient setting,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1841.25,75,,1473,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,859.25,35,,687.4,percent of total billed charges,35% of total billed charges for outpatient setting,1914.9,78,,1531.92,percent of total billed charges,78% of total billed charges for outpatient setting,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1718.5,70,,1374.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1841.25,75,,1473,percent of total billed charges,75% of total billed charges for outpatient setting,2037.65,83,,1630.12,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.57,39.17,,769.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,859.25,3141,
OPEN TREAT PHAL OR MID PHLA W,4400043,CDM,360,RC,26735,HCPCS,outpatient,,,1612,806,,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,619.01,38.4,,495.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.01,38.4,,495.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,1209,75,,967.2,percent of total billed charges,75% of total billed charges for outpatient setting,1209,75,,967.2,percent of total billed charges,75% of total billed charges for outpatient setting,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,1209,75,,967.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,564.2,35,,451.36,percent of total billed charges,35% of total billed charges for outpatient setting,1257.36,78,,1005.888,percent of total billed charges,78% of total billed charges for outpatient setting,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,1128.4,70,,902.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1209,75,,967.2,percent of total billed charges,75% of total billed charges for outpatient setting,1337.96,83,,1070.368,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,631.39,39.17,,505.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,564.2,3141,
AMPUTATION FOOT (SYME PROCEDU),4400044,CDM,360,RC,27888,HCPCS,outpatient,,,2427,1213.5,,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,2427,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,931.97,38.4,,745.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,931.97,38.4,,745.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,1820.25,75,,1456.2,percent of total billed charges,75% of total billed charges for outpatient setting,1820.25,75,,1456.2,percent of total billed charges,75% of total billed charges for outpatient setting,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,1820.25,75,,1456.2,percent of total billed charges,75% of total billed charges for outpatient setting,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,849.45,35,,679.56,percent of total billed charges,35% of total billed charges for outpatient setting,1893.06,78,,1514.448,percent of total billed charges,78% of total billed charges for outpatient setting,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,1698.9,70,,1359.12,percent of total billed charges,70% of total billed charges for outpatient setting,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1820.25,75,,1456.2,percent of total billed charges,75% of total billed charges for outpatient setting,2014.41,83,,1611.528,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,950.61,39.17,,760.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2427,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,849.45,5560,
EXCISION MORTON'S NEUROMA,4400045,CDM,360,RC,28080,HCPCS,outpatient,,,2082,1041,,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,799.49,38.4,,639.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,799.49,38.4,,639.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1561.5,75,,1249.2,percent of total billed charges,75% of total billed charges for outpatient setting,1561.5,75,,1249.2,percent of total billed charges,75% of total billed charges for outpatient setting,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1561.5,75,,1249.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,728.7,35,,582.96,percent of total billed charges,35% of total billed charges for outpatient setting,1623.96,78,,1299.168,percent of total billed charges,78% of total billed charges for outpatient setting,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1457.4,70,,1165.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1561.5,75,,1249.2,percent of total billed charges,75% of total billed charges for outpatient setting,1728.06,83,,1382.448,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,815.48,39.17,,652.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,728.7,3141,
AMPUT TOE INTERPHALANGEAL JOIN,4400046,CDM,360,RC,28825,HCPCS,outpatient,,,1102,551,,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,423.17,38.4,,338.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,423.17,38.4,,338.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,826.5,75,,661.2,percent of total billed charges,75% of total billed charges for outpatient setting,826.5,75,,661.2,percent of total billed charges,75% of total billed charges for outpatient setting,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,826.5,75,,661.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,385.7,35,,308.56,percent of total billed charges,35% of total billed charges for outpatient setting,859.56,78,,687.648,percent of total billed charges,78% of total billed charges for outpatient setting,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,771.4,70,,617.12,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,826.5,75,,661.2,percent of total billed charges,75% of total billed charges for outpatient setting,914.66,83,,731.728,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,431.63,39.17,,345.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,385.7,3141,
DRBDE SUCUT EPID&DERMIS 20CM<,4400047,CDM,360,RC,11042,HCPCS,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.9,35,,54.32,percent of total billed charges,35% of total billed charges for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.99,39.17,,60.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.9,659,
REPAIR RUPTURED ROTAT CUFF CHR,4400048,CDM,360,RC,23412,HCPCS,outpatient,,,2856,1428,,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1096.7,38.4,,877.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1096.7,38.4,,877.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,2142,75,,1713.6,percent of total billed charges,75% of total billed charges for outpatient setting,2142,75,,1713.6,percent of total billed charges,75% of total billed charges for outpatient setting,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,2142,75,,1713.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,999.6,35,,799.68,percent of total billed charges,35% of total billed charges for outpatient setting,2227.68,78,,1782.144,percent of total billed charges,78% of total billed charges for outpatient setting,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,1999.2,70,,1599.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2142,75,,1713.6,percent of total billed charges,75% of total billed charges for outpatient setting,2370.48,83,,1896.384,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1118.63,39.17,,894.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,999.6,6145.19,
HALLUX VALGUS CORRECTION,4400049,CDM,360,RC,28290,HCPCS,outpatient,,,1351,675.5,,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,518.78,38.4,,415.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,518.78,38.4,,415.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,1013.25,75,,810.6,percent of total billed charges,75% of total billed charges for outpatient setting,1013.25,75,,810.6,percent of total billed charges,75% of total billed charges for outpatient setting,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,1013.25,75,,810.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,472.85,35,,378.28,percent of total billed charges,35% of total billed charges for outpatient setting,1053.78,78,,843.024,percent of total billed charges,78% of total billed charges for outpatient setting,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,945.7,70,,756.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1013.25,75,,810.6,percent of total billed charges,75% of total billed charges for outpatient setting,1121.33,83,,897.064,percent of total billed charges,83% of total billed charges for outpatient setting,675.5,50,,540.4,percent of total billed charges,50% of total billed charges for outpatient setting,675.5,50,,540.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,529.16,39.17,,423.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,472.85,1121.33,
ARTHROSCOPY KNEE CHONDROPLASTY,4400050,CDM,360,RC,29877,HCPCS,outpatient,,,5207,2603.5,,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,35,,1457.96,percent of total billed charges,35% of total billed charges for outpatient setting,4061.46,78,,3249.168,percent of total billed charges,78% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,4321.81,83,,3457.448,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2039.48,39.17,,1631.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,4321.81,
CLAVICULECTOMY PARTIAL,4400051,CDM,360,RC,23120,HCPCS,outpatient,,,1694,847,,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,650.5,38.4,,520.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,650.5,38.4,,520.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,1270.5,75,,1016.4,percent of total billed charges,75% of total billed charges for outpatient setting,1270.5,75,,1016.4,percent of total billed charges,75% of total billed charges for outpatient setting,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,1270.5,75,,1016.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,592.9,35,,474.32,percent of total billed charges,35% of total billed charges for outpatient setting,1321.32,78,,1057.056,percent of total billed charges,78% of total billed charges for outpatient setting,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,1185.8,70,,948.64,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1270.5,75,,1016.4,percent of total billed charges,75% of total billed charges for outpatient setting,1406.02,83,,1124.816,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,663.51,39.17,,530.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,592.9,3868,
REMOVAL OF IMPLANT SUPERFICIAL,4400052,CDM,360,RC,20670,HCPCS,outpatient,,,824,412,,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,316.42,38.4,,253.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,316.42,38.4,,253.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,288.4,35,,230.72,percent of total billed charges,35% of total billed charges for outpatient setting,642.72,78,,514.176,percent of total billed charges,78% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,576.8,70,,461.44,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,618,75,,494.4,percent of total billed charges,75% of total billed charges for outpatient setting,683.92,83,,547.136,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,322.75,39.17,,258.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,288.4,2175,
EXCISION OLECRANON BURSA,4400053,CDM,360,RC,24105,HCPCS,outpatient,,,2371,1185.5,,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,910.46,38.4,,728.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,910.46,38.4,,728.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,1778.25,75,,1422.6,percent of total billed charges,75% of total billed charges for outpatient setting,1778.25,75,,1422.6,percent of total billed charges,75% of total billed charges for outpatient setting,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,1778.25,75,,1422.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,829.85,35,,663.88,percent of total billed charges,35% of total billed charges for outpatient setting,1849.38,78,,1479.504,percent of total billed charges,78% of total billed charges for outpatient setting,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,1659.7,70,,1327.76,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1778.25,75,,1422.6,percent of total billed charges,75% of total billed charges for outpatient setting,1967.93,83,,1574.344,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,928.67,39.17,,742.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,829.85,3141,
TENOTOMY OPEN TENDON FLEX S/M,4400054,CDM,360,RC,28230,HCPCS,outpatient,,,740,370,,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,284.16,38.4,,227.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,284.16,38.4,,227.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,555,75,,444,percent of total billed charges,75% of total billed charges for outpatient setting,555,75,,444,percent of total billed charges,75% of total billed charges for outpatient setting,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,555,75,,444,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,259,35,,207.2,percent of total billed charges,35% of total billed charges for outpatient setting,577.2,78,,461.76,percent of total billed charges,78% of total billed charges for outpatient setting,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,518,70,,414.4,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,555,75,,444,percent of total billed charges,75% of total billed charges for outpatient setting,614.2,83,,491.36,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.84,39.17,,231.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,259,3141,
CLOSED TX RAD/ULNAR SHAFT FX,4400055,CDM,360,RC,25565,HCPCS,outpatient,,,1416,708,,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,543.74,38.4,,434.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,543.74,38.4,,434.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,1062,75,,849.6,percent of total billed charges,75% of total billed charges for outpatient setting,1062,75,,849.6,percent of total billed charges,75% of total billed charges for outpatient setting,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,1062,75,,849.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,495.6,35,,396.48,percent of total billed charges,35% of total billed charges for outpatient setting,1104.48,78,,883.584,percent of total billed charges,78% of total billed charges for outpatient setting,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,991.2,70,,792.96,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1062,75,,849.6,percent of total billed charges,75% of total billed charges for outpatient setting,1175.28,83,,940.224,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,554.61,39.17,,443.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,495.6,1380.55,
DEBRD INFECT SKIN UP TO 10% BO,4400056,CDM,360,RC,11000,HCPCS,outpatient,,,86,43,,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.02,38.4,,26.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.1,35,,24.08,percent of total billed charges,35% of total billed charges for outpatient setting,67.08,78,,53.664,percent of total billed charges,78% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,60.2,70,,48.16,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.5,75,,51.6,percent of total billed charges,75% of total billed charges for outpatient setting,71.38,83,,57.104,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.68,39.17,,26.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.1,659,
EXC BONE CYST PHALANGES OF FOO,4400057,CDM,360,RC,28108,HCPCS,outpatient,,,986,493,,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,378.62,38.4,,302.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,378.62,38.4,,302.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,739.5,75,,591.6,percent of total billed charges,75% of total billed charges for outpatient setting,739.5,75,,591.6,percent of total billed charges,75% of total billed charges for outpatient setting,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,739.5,75,,591.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.1,35,,276.08,percent of total billed charges,35% of total billed charges for outpatient setting,769.08,78,,615.264,percent of total billed charges,78% of total billed charges for outpatient setting,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,690.2,70,,552.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,739.5,75,,591.6,percent of total billed charges,75% of total billed charges for outpatient setting,818.38,83,,654.704,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,386.19,39.17,,308.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.1,3141,
TENOTOMY OP FLEX TEND FOOT S/M,4400058,CDM,360,RC,28230,HCPCS,outpatient,,,1625,812.5,,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,624,38.4,,499.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,624,38.4,,499.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1218.75,75,,975,percent of total billed charges,75% of total billed charges for outpatient setting,1218.75,75,,975,percent of total billed charges,75% of total billed charges for outpatient setting,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1218.75,75,,975,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,568.75,35,,455,percent of total billed charges,35% of total billed charges for outpatient setting,1267.5,78,,1014,percent of total billed charges,78% of total billed charges for outpatient setting,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1137.5,70,,910,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1218.75,75,,975,percent of total billed charges,75% of total billed charges for outpatient setting,1348.75,83,,1079,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,636.48,39.17,,509.184,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,568.75,3141,
DESTRUCTION WART,4400059,CDM,360,RC,17110,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.55,659,
EXC SOFT TISSUE MASS HAND/FING,4400060,CDM,360,RC,26115,HCPCS,outpatient,,,1412,706,,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,542.21,38.4,,433.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,542.21,38.4,,433.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,1059,75,,847.2,percent of total billed charges,75% of total billed charges for outpatient setting,1059,75,,847.2,percent of total billed charges,75% of total billed charges for outpatient setting,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,1059,75,,847.2,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,494.2,35,,395.36,percent of total billed charges,35% of total billed charges for outpatient setting,1101.36,78,,881.088,percent of total billed charges,78% of total billed charges for outpatient setting,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,988.4,70,,790.72,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1059,75,,847.2,percent of total billed charges,75% of total billed charges for outpatient setting,1171.96,83,,937.568,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,553.05,39.17,,442.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,494.2,2175,
EXC BONE CYST FINGER,4400061,CDM,360,RC,26210,HCPCS,outpatient,,,3164,1582,,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,35,,885.92,percent of total billed charges,35% of total billed charges for outpatient setting,2467.92,78,,1974.336,percent of total billed charges,78% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2626.12,83,,2100.896,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1239.28,39.17,,991.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,2626.12,
CUBITAL TUNNELL RELEASE,4400062,CDM,360,RC,64718,HCPCS,outpatient,,,1903,951.5,,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1658.5,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,730.75,38.4,,584.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,730.75,38.4,,584.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges for outpatient setting,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges for outpatient setting,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,666.05,35,,532.84,percent of total billed charges,35% of total billed charges for outpatient setting,1484.34,78,,1187.472,percent of total billed charges,78% of total billed charges for outpatient setting,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1332.1,70,,1065.68,percent of total billed charges,70% of total billed charges for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1427.25,75,,1141.8,percent of total billed charges,75% of total billed charges for outpatient setting,1579.49,83,,1263.592,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,745.37,39.17,,596.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1658.5,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,666.05,3141,
CORRECT HALLUX VALGUS (BUN)MCT,4400063,CDM,360,RC,28296,HCPCS,outpatient,,,1983,991.5,,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,761.47,38.4,,609.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,761.47,38.4,,609.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,1487.25,75,,1189.8,percent of total billed charges,75% of total billed charges for outpatient setting,1487.25,75,,1189.8,percent of total billed charges,75% of total billed charges for outpatient setting,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,1487.25,75,,1189.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,694.05,35,,555.24,percent of total billed charges,35% of total billed charges for outpatient setting,1546.74,78,,1237.392,percent of total billed charges,78% of total billed charges for outpatient setting,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,1388.1,70,,1110.48,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1487.25,75,,1189.8,percent of total billed charges,75% of total billed charges for outpatient setting,1645.89,83,,1316.712,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,776.7,39.17,,621.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,694.05,3868,
SHORT ARM,4400064,CDM,360,RC,29075,HCPCS,outpatient,,,204,102,,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,78.34,38.4,,62.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.34,38.4,,62.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.4,35,,57.12,percent of total billed charges,35% of total billed charges for outpatient setting,159.12,78,,127.296,percent of total billed charges,78% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,142.8,70,,114.24,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153,75,,122.4,percent of total billed charges,75% of total billed charges for outpatient setting,169.32,83,,135.456,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,79.91,39.17,,63.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.4,659,
CLOSED TX ANKLE DISLOCATION,4400065,CDM,360,RC,27842,HCPCS,outpatient,,,1244,622,,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,477.7,38.4,,382.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,477.7,38.4,,382.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,933,75,,746.4,percent of total billed charges,75% of total billed charges for outpatient setting,933,75,,746.4,percent of total billed charges,75% of total billed charges for outpatient setting,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,933,75,,746.4,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,435.4,35,,348.32,percent of total billed charges,35% of total billed charges for outpatient setting,970.32,78,,776.256,percent of total billed charges,78% of total billed charges for outpatient setting,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,870.8,70,,696.64,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,933,75,,746.4,percent of total billed charges,75% of total billed charges for outpatient setting,1032.52,83,,826.016,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,487.25,39.17,,389.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,435.4,2175,
TENOTOMY FLEX TENDON TOE EACH,4400066,CDM,360,RC,28232,HCPCS,outpatient,,,681,340.5,,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.35,35,,190.68,percent of total billed charges,35% of total billed charges for outpatient setting,531.18,78,,424.944,percent of total billed charges,78% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,565.23,83,,452.184,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,266.73,39.17,,213.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.35,3141,
CLOSED TX SHOULDER DISLOCATION,4400067,CDM,360,RC,23650,HCPCS,outpatient,,,884,442,,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,339.46,38.4,,271.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.46,38.4,,271.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,663,75,,530.4,percent of total billed charges,75% of total billed charges for outpatient setting,663,75,,530.4,percent of total billed charges,75% of total billed charges for outpatient setting,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,663,75,,530.4,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.4,35,,247.52,percent of total billed charges,35% of total billed charges for outpatient setting,689.52,78,,551.616,percent of total billed charges,78% of total billed charges for outpatient setting,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,618.8,70,,495.04,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,663,75,,530.4,percent of total billed charges,75% of total billed charges for outpatient setting,733.72,83,,586.976,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,346.25,39.17,,277,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,733.72,
CLOSED TX PROX HUMERUS FX W/ M,4400068,CDM,360,RC,23605,HCPCS,outpatient,,,1267,633.5,,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,486.53,38.4,,389.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,486.53,38.4,,389.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,950.25,75,,760.2,percent of total billed charges,75% of total billed charges for outpatient setting,950.25,75,,760.2,percent of total billed charges,75% of total billed charges for outpatient setting,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,950.25,75,,760.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,443.45,35,,354.76,percent of total billed charges,35% of total billed charges for outpatient setting,988.26,78,,790.608,percent of total billed charges,78% of total billed charges for outpatient setting,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,886.9,70,,709.52,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,950.25,75,,760.2,percent of total billed charges,75% of total billed charges for outpatient setting,1051.61,83,,841.288,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,496.26,39.17,,397.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,443.45,3141,
SYNOVECTOMY EXTENSOR TENDON WR,4400069,CDM,360,RC,25118,HCPCS,outpatient,,,1438,719,,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,552.19,38.4,,441.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,552.19,38.4,,441.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1078.5,75,,862.8,percent of total billed charges,75% of total billed charges for outpatient setting,1078.5,75,,862.8,percent of total billed charges,75% of total billed charges for outpatient setting,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1078.5,75,,862.8,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,503.3,35,,402.64,percent of total billed charges,35% of total billed charges for outpatient setting,1121.64,78,,897.312,percent of total billed charges,78% of total billed charges for outpatient setting,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1006.6,70,,805.28,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1078.5,75,,862.8,percent of total billed charges,75% of total billed charges for outpatient setting,1193.54,83,,954.832,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,563.23,39.17,,450.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,503.3,3141,
CLOSED TX SHLDER D'LOC W/MANIP,4400070,CDM,360,RC,23655,HCPCS,outpatient,,,1040,520,,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,399.36,38.4,,319.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,399.36,38.4,,319.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,780,75,,624,percent of total billed charges,75% of total billed charges for outpatient setting,780,75,,624,percent of total billed charges,75% of total billed charges for outpatient setting,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,780,75,,624,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,364,35,,291.2,percent of total billed charges,35% of total billed charges for outpatient setting,811.2,78,,648.96,percent of total billed charges,78% of total billed charges for outpatient setting,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,728,70,,582.4,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,780,75,,624,percent of total billed charges,75% of total billed charges for outpatient setting,863.2,83,,690.56,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,407.35,39.17,,325.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,364,2175,
REM FOREIGN BDY MUS TEND SHEA,4400071,CDM,360,RC,20525,HCPCS,outpatient,,,860,430,,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,330.24,38.4,,264.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330.24,38.4,,264.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,645,75,,516,percent of total billed charges,75% of total billed charges for outpatient setting,645,75,,516,percent of total billed charges,75% of total billed charges for outpatient setting,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,645,75,,516,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,301,35,,240.8,percent of total billed charges,35% of total billed charges for outpatient setting,670.8,78,,536.64,percent of total billed charges,78% of total billed charges for outpatient setting,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,602,70,,481.6,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,645,75,,516,percent of total billed charges,75% of total billed charges for outpatient setting,713.8,83,,571.04,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,336.84,39.17,,269.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,301,3141,
EXC/CUT BONE CYST/BENIGN TUMOR,4400072,CDM,360,RC,27355,HCPCS,outpatient,,,2282,1141,,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,876.29,38.4,,701.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,876.29,38.4,,701.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,798.7,35,,638.96,percent of total billed charges,35% of total billed charges for outpatient setting,1779.96,78,,1423.968,percent of total billed charges,78% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,1597.4,70,,1277.92,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1711.5,75,,1369.2,percent of total billed charges,75% of total billed charges for outpatient setting,1894.06,83,,1515.248,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,893.82,39.17,,715.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,798.7,3868,
EXC NAIL&NAIL MATRIX PART/COMP,4400073,CDM,360,RC,11750,HCPCS,outpatient,,,381,190.5,,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,146.3,38.4,,117.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,146.3,38.4,,117.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,285.75,75,,228.6,percent of total billed charges,75% of total billed charges for outpatient setting,285.75,75,,228.6,percent of total billed charges,75% of total billed charges for outpatient setting,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,285.75,75,,228.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133.35,35,,106.68,percent of total billed charges,35% of total billed charges for outpatient setting,297.18,78,,237.744,percent of total billed charges,78% of total billed charges for outpatient setting,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,266.7,70,,213.36,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,285.75,75,,228.6,percent of total billed charges,75% of total billed charges for outpatient setting,316.23,83,,252.984,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,149.23,39.17,,119.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,133.35,659,
CORRECT HALLUX VALGUS (BUN)MCT,4400074,CDM,360,RC,28296,HCPCS,outpatient,,,4356,2178,,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1672.7,38.4,,1338.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1672.7,38.4,,1338.16,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,3267,75,,2613.6,percent of total billed charges,75% of total billed charges for outpatient setting,3267,75,,2613.6,percent of total billed charges,75% of total billed charges for outpatient setting,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,3267,75,,2613.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1524.6,35,,1219.68,percent of total billed charges,35% of total billed charges for outpatient setting,3397.68,78,,2718.144,percent of total billed charges,78% of total billed charges for outpatient setting,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,3049.2,70,,2439.36,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3267,75,,2613.6,percent of total billed charges,75% of total billed charges for outpatient setting,3615.48,83,,2892.384,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1706.15,39.17,,1364.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1524.6,3868,
REPAIR FLEX TDON FINGER EA WO,4400075,CDM,360,RC,26356,HCPCS,outpatient,,,3177,1588.5,,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1219.97,38.4,,975.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1219.97,38.4,,975.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2382.75,75,,1906.2,percent of total billed charges,75% of total billed charges for outpatient setting,2382.75,75,,1906.2,percent of total billed charges,75% of total billed charges for outpatient setting,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2382.75,75,,1906.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1111.95,35,,889.56,percent of total billed charges,35% of total billed charges for outpatient setting,2478.06,78,,1982.448,percent of total billed charges,78% of total billed charges for outpatient setting,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2223.9,70,,1779.12,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2382.75,75,,1906.2,percent of total billed charges,75% of total billed charges for outpatient setting,2636.91,83,,2109.528,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1244.37,39.17,,995.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1111.95,3868,
CLOSED TX BIMALL ANKLE FX W/ M,4400076,CDM,360,RC,27810,HCPCS,outpatient,,,1435,717.5,,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,551.04,38.4,,440.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,551.04,38.4,,440.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.25,35,,401.8,percent of total billed charges,35% of total billed charges for outpatient setting,1119.3,78,,895.44,percent of total billed charges,78% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1191.05,83,,952.84,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,562.06,39.17,,449.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.25,1452,
OPEN TX RADIAL SHAFT FX INCL I,4400077,CDM,360,RC,25515,HCPCS,outpatient,,,1971,985.5,,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,756.86,38.4,,605.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,756.86,38.4,,605.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,1478.25,75,,1182.6,percent of total billed charges,75% of total billed charges for outpatient setting,1478.25,75,,1182.6,percent of total billed charges,75% of total billed charges for outpatient setting,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,1478.25,75,,1182.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,689.85,35,,551.88,percent of total billed charges,35% of total billed charges for outpatient setting,1537.38,78,,1229.904,percent of total billed charges,78% of total billed charges for outpatient setting,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,1379.7,70,,1103.76,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1478.25,75,,1182.6,percent of total billed charges,75% of total billed charges for outpatient setting,1635.93,83,,1308.744,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,772,39.17,,617.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,689.85,6145.19,
EXC LESION TEDON CAPSULE FOOT,4400078,CDM,360,RC,28090,HCPCS,outpatient,,,907,453.5,,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,348.29,38.4,,278.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,348.29,38.4,,278.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,680.25,75,,544.2,percent of total billed charges,75% of total billed charges for outpatient setting,680.25,75,,544.2,percent of total billed charges,75% of total billed charges for outpatient setting,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,680.25,75,,544.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,317.45,35,,253.96,percent of total billed charges,35% of total billed charges for outpatient setting,707.46,78,,565.968,percent of total billed charges,78% of total billed charges for outpatient setting,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,634.9,70,,507.92,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,680.25,75,,544.2,percent of total billed charges,75% of total billed charges for outpatient setting,752.81,83,,602.248,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,355.26,39.17,,284.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,317.45,3141,
PLANTAR FASCIECTOMY PARTIAL,4400079,CDM,360,RC,28060,HCPCS,outpatient,,,1003,501.5,,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,385.15,38.4,,308.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385.15,38.4,,308.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,752.25,75,,601.8,percent of total billed charges,75% of total billed charges for outpatient setting,752.25,75,,601.8,percent of total billed charges,75% of total billed charges for outpatient setting,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,752.25,75,,601.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.05,35,,280.84,percent of total billed charges,35% of total billed charges for outpatient setting,782.34,78,,625.872,percent of total billed charges,78% of total billed charges for outpatient setting,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,702.1,70,,561.68,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,752.25,75,,601.8,percent of total billed charges,75% of total billed charges for outpatient setting,832.49,83,,665.992,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,392.85,39.17,,314.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,351.05,3141,
OSTEO HEEL SPUR W/WO PLANTAR F,4400080,CDM,360,RC,28119,HCPCS,outpatient,,,1166,583,,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,447.74,38.4,,358.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,447.74,38.4,,358.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.1,35,,326.48,percent of total billed charges,35% of total billed charges for outpatient setting,909.48,78,,727.584,percent of total billed charges,78% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,967.78,83,,774.224,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456.69,39.17,,365.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.1,3141,
SUTURE INFRAPATELLAR TEDON PRI,4400081,CDM,360,RC,27380,HCPCS,outpatient,,,1981,990.5,,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,760.7,38.4,,608.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,760.7,38.4,,608.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,1485.75,75,,1188.6,percent of total billed charges,75% of total billed charges for outpatient setting,1485.75,75,,1188.6,percent of total billed charges,75% of total billed charges for outpatient setting,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,1485.75,75,,1188.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,693.35,35,,554.68,percent of total billed charges,35% of total billed charges for outpatient setting,1545.18,78,,1236.144,percent of total billed charges,78% of total billed charges for outpatient setting,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,1386.7,70,,1109.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1485.75,75,,1188.6,percent of total billed charges,75% of total billed charges for outpatient setting,1644.23,83,,1315.384,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,775.91,39.17,,620.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,693.35,6145.19,
SUTURE QUAD/HAMSTRINGS MUSLCE,4400082,CDM,360,RC,27385,HCPCS,outpatient,,,2228,1114,,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,855.55,38.4,,684.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,855.55,38.4,,684.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,1671,75,,1336.8,percent of total billed charges,75% of total billed charges for outpatient setting,1671,75,,1336.8,percent of total billed charges,75% of total billed charges for outpatient setting,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,1671,75,,1336.8,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,779.8,35,,623.84,percent of total billed charges,35% of total billed charges for outpatient setting,1737.84,78,,1390.272,percent of total billed charges,78% of total billed charges for outpatient setting,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,1559.6,70,,1247.68,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1671,75,,1336.8,percent of total billed charges,75% of total billed charges for outpatient setting,1849.24,83,,1479.392,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,872.66,39.17,,698.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,779.8,6145.19,
EX BENIGN LESION INC. MSNHFG 5,4400083,CDM,360,RC,11420,HCPCS,outpatient,,,205,102.5,,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,78.72,38.4,,62.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.72,38.4,,62.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.75,35,,57.4,percent of total billed charges,35% of total billed charges for outpatient setting,159.9,78,,127.92,percent of total billed charges,78% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,170.15,83,,136.12,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.29,39.17,,64.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.75,1452,
REPAIR INTERMID WOUND 2.5CMOR<,4400084,CDM,360,RC,12041,HCPCS,outpatient,,,408,204,,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,156.67,38.4,,125.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.67,38.4,,125.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.8,35,,114.24,percent of total billed charges,35% of total billed charges for outpatient setting,318.24,78,,254.592,percent of total billed charges,78% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.64,83,,270.912,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.8,39.17,,127.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.8,659,
EXC BENIGN LESION EXCPT .5CM<,4400085,CDM,360,RC,11420,HCPCS,outpatient,,,205,102.5,,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,78.72,38.4,,62.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.72,38.4,,62.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.75,35,,57.4,percent of total billed charges,35% of total billed charges for outpatient setting,159.9,78,,127.92,percent of total billed charges,78% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,143.5,70,,114.8,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,153.75,75,,123,percent of total billed charges,75% of total billed charges for outpatient setting,170.15,83,,136.12,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.29,39.17,,64.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.75,1452,
OPEN TX INTERPHALANGEAL JT DIS,4400086,CDM,360,RC,26785,HCPCS,outpatient,,,1373,686.5,,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,527.23,38.4,,421.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,527.23,38.4,,421.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,1029.75,75,,823.8,percent of total billed charges,75% of total billed charges for outpatient setting,1029.75,75,,823.8,percent of total billed charges,75% of total billed charges for outpatient setting,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,1029.75,75,,823.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,480.55,35,,384.44,percent of total billed charges,35% of total billed charges for outpatient setting,1070.94,78,,856.752,percent of total billed charges,78% of total billed charges for outpatient setting,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,961.1,70,,768.88,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1029.75,75,,823.8,percent of total billed charges,75% of total billed charges for outpatient setting,1139.59,83,,911.672,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,537.77,39.17,,430.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,480.55,3141,
CLOSED TX BIMALLEOLAR ANKLE FX,4400087,CDM,360,RC,27810,HCPCS,outpatient,,,1435,717.5,,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,551.04,38.4,,440.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,551.04,38.4,,440.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.25,35,,401.8,percent of total billed charges,35% of total billed charges for outpatient setting,1119.3,78,,895.44,percent of total billed charges,78% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1004.5,70,,803.6,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1076.25,75,,861,percent of total billed charges,75% of total billed charges for outpatient setting,1191.05,83,,952.84,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,562.06,39.17,,449.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.25,1452,
EXC. LESION TENDON SHEATH/JNT,4400088,CDM,360,RC,26160,HCPCS,outpatient,,,2887,1443.5,,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1108.61,38.4,,886.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1108.61,38.4,,886.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,2165.25,75,,1732.2,percent of total billed charges,75% of total billed charges for outpatient setting,2165.25,75,,1732.2,percent of total billed charges,75% of total billed charges for outpatient setting,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,2165.25,75,,1732.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1010.45,35,,808.36,percent of total billed charges,35% of total billed charges for outpatient setting,2251.86,78,,1801.488,percent of total billed charges,78% of total billed charges for outpatient setting,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,2020.9,70,,1616.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2165.25,75,,1732.2,percent of total billed charges,75% of total billed charges for outpatient setting,2396.21,83,,1916.968,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1130.78,39.17,,904.624,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1010.45,2396.21,
CLOSED TX POST HIP ARTHROPLAST,4400089,CDM,360,RC,27266,HCPCS,outpatient,,,1605,802.5,,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,616.32,38.4,,493.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,616.32,38.4,,493.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1203.75,75,,963,percent of total billed charges,75% of total billed charges for outpatient setting,1203.75,75,,963,percent of total billed charges,75% of total billed charges for outpatient setting,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1203.75,75,,963,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.75,35,,449.4,percent of total billed charges,35% of total billed charges for outpatient setting,1251.9,78,,1001.52,percent of total billed charges,78% of total billed charges for outpatient setting,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1123.5,70,,898.8,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1203.75,75,,963,percent of total billed charges,75% of total billed charges for outpatient setting,1332.15,83,,1065.72,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,628.65,39.17,,502.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,561.75,2175,
OPEN TX CALCANEAL FX INCL INTE,4400090,CDM,360,RC,28415,HCPCS,outpatient,,,2943,1471.5,,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1130.11,38.4,,904.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1130.11,38.4,,904.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,2207.25,75,,1765.8,percent of total billed charges,75% of total billed charges for outpatient setting,2207.25,75,,1765.8,percent of total billed charges,75% of total billed charges for outpatient setting,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,2207.25,75,,1765.8,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1030.05,35,,824.04,percent of total billed charges,35% of total billed charges for outpatient setting,2295.54,78,,1836.432,percent of total billed charges,78% of total billed charges for outpatient setting,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,2060.1,70,,1648.08,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2207.25,75,,1765.8,percent of total billed charges,75% of total billed charges for outpatient setting,2442.69,83,,1954.152,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1152.71,39.17,,922.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1030.05,6145.19,
REPAIR EXTENSOR TENDON HAND WO,4400091,CDM,360,RC,26410,HCPCS,outpatient,,,1662,831,,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,638.21,38.4,,510.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,638.21,38.4,,510.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1246.5,75,,997.2,percent of total billed charges,75% of total billed charges for outpatient setting,1246.5,75,,997.2,percent of total billed charges,75% of total billed charges for outpatient setting,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1246.5,75,,997.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,581.7,35,,465.36,percent of total billed charges,35% of total billed charges for outpatient setting,1296.36,78,,1037.088,percent of total billed charges,78% of total billed charges for outpatient setting,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1163.4,70,,930.72,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1246.5,75,,997.2,percent of total billed charges,75% of total billed charges for outpatient setting,1379.46,83,,1103.568,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,650.97,39.17,,520.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,581.7,2175,
REMOVAL FOREIGN BODY FOOT,4400092,CDM,360,RC,28192,HCPCS,outpatient,,,875,437.5,,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,336,38.4,,268.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336,38.4,,268.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.25,35,,245,percent of total billed charges,35% of total billed charges for outpatient setting,682.5,78,,546,percent of total billed charges,78% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,612.5,70,,490,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,656.25,75,,525,percent of total billed charges,75% of total billed charges for outpatient setting,726.25,83,,581,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.72,39.17,,274.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.25,2175,
DEBRD NAILS BY ANY METHOD 6 OR,4400093,CDM,360,RC,11721,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.8,659,
APPLICATION LONG LEG CAST,4400094,CDM,360,RC,29345,HCPCS,outpatient,,,337,168.5,,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,129.41,38.4,,103.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.41,38.4,,103.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,252.75,75,,202.2,percent of total billed charges,75% of total billed charges for outpatient setting,252.75,75,,202.2,percent of total billed charges,75% of total billed charges for outpatient setting,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,252.75,75,,202.2,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.95,35,,94.36,percent of total billed charges,35% of total billed charges for outpatient setting,262.86,78,,210.288,percent of total billed charges,78% of total billed charges for outpatient setting,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,235.9,70,,188.72,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252.75,75,,202.2,percent of total billed charges,75% of total billed charges for outpatient setting,279.71,83,,223.768,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,132,39.17,,105.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,117.95,659,
CLOSED TX LAT MALL FX ANKLE MA,4400095,CDM,360,RC,27788,HCPCS,outpatient,,,1097,548.5,,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,421.25,38.4,,337,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,421.25,38.4,,337,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,822.75,75,,658.2,percent of total billed charges,75% of total billed charges for outpatient setting,822.75,75,,658.2,percent of total billed charges,75% of total billed charges for outpatient setting,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,822.75,75,,658.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,383.95,35,,307.16,percent of total billed charges,35% of total billed charges for outpatient setting,855.66,78,,684.528,percent of total billed charges,78% of total billed charges for outpatient setting,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,767.9,70,,614.32,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,822.75,75,,658.2,percent of total billed charges,75% of total billed charges for outpatient setting,910.51,83,,728.408,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,429.68,39.17,,343.744,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,910.51,
DEBRIDEMENT OF NAILS1 TO 5,4400096,CDM,360,RC,11720,HCPCS,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,659,
OPEN TX MED MALLEOLUS FX ANKLE,4400097,CDM,360,RC,27766,HCPCS,outpatient,,,1906,953,,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,731.9,38.4,,585.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,731.9,38.4,,585.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,1429.5,75,,1143.6,percent of total billed charges,75% of total billed charges for outpatient setting,1429.5,75,,1143.6,percent of total billed charges,75% of total billed charges for outpatient setting,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,1429.5,75,,1143.6,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,667.1,35,,533.68,percent of total billed charges,35% of total billed charges for outpatient setting,1486.68,78,,1189.344,percent of total billed charges,78% of total billed charges for outpatient setting,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,1334.2,70,,1067.36,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1429.5,75,,1143.6,percent of total billed charges,75% of total billed charges for outpatient setting,1581.98,83,,1265.584,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,746.54,39.17,,597.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,667.1,6145.19,
CLOSED TX DISTAL TIBIA TX W/ M,4400098,CDM,360,RC,27825,HCPCS,outpatient,,,1811,905.5,,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,695.42,38.4,,556.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,695.42,38.4,,556.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1358.25,75,,1086.6,percent of total billed charges,75% of total billed charges for outpatient setting,1358.25,75,,1086.6,percent of total billed charges,75% of total billed charges for outpatient setting,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1358.25,75,,1086.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,633.85,35,,507.08,percent of total billed charges,35% of total billed charges for outpatient setting,1412.58,78,,1130.064,percent of total billed charges,78% of total billed charges for outpatient setting,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1267.7,70,,1014.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1358.25,75,,1086.6,percent of total billed charges,75% of total billed charges for outpatient setting,1503.13,83,,1202.504,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,709.33,39.17,,567.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,633.85,2175,
DEST. SURG CURETTEMENT 1ST LES,4400099,CDM,360,RC,17000,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,35,,37.24,percent of total billed charges,35% of total billed charges for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.09,39.17,,41.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,659,
DEST SURG CURETTEMENT 2ND-14TH,4400100,CDM,360,RC,17003,HCPCS,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,659,
PARTIAL EXC BONE TARSAL OR MET,4400101,CDM,360,RC,28122,HCPCS,outpatient,,,1404,702,,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,539.14,38.4,,431.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539.14,38.4,,431.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,1053,75,,842.4,percent of total billed charges,75% of total billed charges for outpatient setting,1053,75,,842.4,percent of total billed charges,75% of total billed charges for outpatient setting,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,1053,75,,842.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,491.4,35,,393.12,percent of total billed charges,35% of total billed charges for outpatient setting,1095.12,78,,876.096,percent of total billed charges,78% of total billed charges for outpatient setting,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,982.8,70,,786.24,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1053,75,,842.4,percent of total billed charges,75% of total billed charges for outpatient setting,1165.32,83,,932.256,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,549.92,39.17,,439.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,491.4,3141,
SUR PREP/CREATE RECIPIENT SITE,4400102,CDM,360,RC,15004,HCPCS,outpatient,,,936,468,,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,359.42,38.4,,287.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,359.42,38.4,,287.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,702,75,,561.6,percent of total billed charges,75% of total billed charges for outpatient setting,702,75,,561.6,percent of total billed charges,75% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,702,75,,561.6,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,327.6,35,,262.08,percent of total billed charges,35% of total billed charges for outpatient setting,730.08,78,,584.064,percent of total billed charges,78% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,655.2,70,,524.16,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,702,75,,561.6,percent of total billed charges,75% of total billed charges for outpatient setting,776.88,83,,621.504,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,366.61,39.17,,293.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,327.6,776.88,
FULL THICKNESS GRAFT INCL CLOS,4400103,CDM,360,RC,15240,HCPCS,outpatient,,,2028,1014,,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,778.75,38.4,,623,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,778.75,38.4,,623,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1521,75,,1216.8,percent of total billed charges,75% of total billed charges for outpatient setting,1521,75,,1216.8,percent of total billed charges,75% of total billed charges for outpatient setting,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1521,75,,1216.8,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,709.8,35,,567.84,percent of total billed charges,35% of total billed charges for outpatient setting,1581.84,78,,1265.472,percent of total billed charges,78% of total billed charges for outpatient setting,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1419.6,70,,1135.68,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1521,75,,1216.8,percent of total billed charges,75% of total billed charges for outpatient setting,1683.24,83,,1346.592,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,794.33,39.17,,635.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,709.8,2175,
CLOSED TX TIBIA FX PROXIMAL W/,4400104,CDM,360,RC,27532,HCPCS,outpatient,,,1712,856,,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,657.41,38.4,,525.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,657.41,38.4,,525.928,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,599.2,35,,479.36,percent of total billed charges,35% of total billed charges for outpatient setting,1335.36,78,,1068.288,percent of total billed charges,78% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,1198.4,70,,958.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1284,75,,1027.2,percent of total billed charges,75% of total billed charges for outpatient setting,1420.96,83,,1136.768,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,670.56,39.17,,536.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,599.2,2780.37,
OPEN TX RADIAL/ULNA W/INTERNAL,4400105,CDM,360,RC,25574,HCPCS,outpatient,,,2170,1085,,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,833.28,38.4,,666.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833.28,38.4,,666.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,1627.5,75,,1302,percent of total billed charges,75% of total billed charges for outpatient setting,1627.5,75,,1302,percent of total billed charges,75% of total billed charges for outpatient setting,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,1627.5,75,,1302,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,759.5,35,,607.6,percent of total billed charges,35% of total billed charges for outpatient setting,1692.6,78,,1354.08,percent of total billed charges,78% of total billed charges for outpatient setting,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,1519,70,,1215.2,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1627.5,75,,1302,percent of total billed charges,75% of total billed charges for outpatient setting,1801.1,83,,1440.88,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,849.95,39.17,,679.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,759.5,6145.19,
CLOSED TX DISTAL RADIOULNA DIS,4400106,CDM,360,RC,25675,HCPCS,outpatient,,,1218,609,,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,467.71,38.4,,374.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,467.71,38.4,,374.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,75,,730.8,percent of total billed charges,75% of total billed charges for outpatient setting,913.5,75,,730.8,percent of total billed charges,75% of total billed charges for outpatient setting,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,75,,730.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,426.3,35,,341.04,percent of total billed charges,35% of total billed charges for outpatient setting,950.04,78,,760.032,percent of total billed charges,78% of total billed charges for outpatient setting,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,852.6,70,,682.08,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,913.5,75,,730.8,percent of total billed charges,75% of total billed charges for outpatient setting,1010.94,83,,808.752,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,477.06,39.17,,381.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,1010.94,
RE-AMPUTATION LEG-TIBIA-FIBULA,4400107,CDM,360,RC,27886,HCPCS,outpatient,,,2180,1090,,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,2180,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,837.12,38.4,,669.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,837.12,38.4,,669.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,1635,75,,1308,percent of total billed charges,75% of total billed charges for outpatient setting,1635,75,,1308,percent of total billed charges,75% of total billed charges for outpatient setting,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,1635,75,,1308,percent of total billed charges,75% of total billed charges for outpatient setting,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,763,35,,610.4,percent of total billed charges,35% of total billed charges for outpatient setting,1700.4,78,,1360.32,percent of total billed charges,78% of total billed charges for outpatient setting,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,1526,70,,1220.8,percent of total billed charges,70% of total billed charges for outpatient setting,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1635,75,,1308,percent of total billed charges,75% of total billed charges for outpatient setting,1809.4,83,,1447.52,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,853.86,39.17,,683.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2180,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,763,5560,
LEVEL 2 OFFICE VISIT EST PAT,4400108,CDM,521,RC,99212,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,37,50,,29.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.9,61.42,
LEVEL 3 OFFICE VISIT EST PAT,4400109,CDM,521,RC,99213,HCPCS,outpatient,,,148,74,,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.83,38.4,,45.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.8,35,,41.44,percent of total billed charges,35% of total billed charges for outpatient setting,115.44,78,,92.352,percent of total billed charges,78% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,103.6,70,,82.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111,75,,88.8,percent of total billed charges,75% of total billed charges for outpatient setting,122.84,83,,98.272,percent of total billed charges,83% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,74,50,,59.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.97,39.17,,46.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,51.8,122.84,
LEVEL 2 OFFICE VISIT NEW PAT,4400110,CDM,521,RC,99202,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.15,35,,47.32,percent of total billed charges,35% of total billed charges for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.2,39.17,,52.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,59.15,140.27,
LEVEL 3 OFFICE VISIT NEW PAT,4400111,CDM,521,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
ASPIR OR INJECT INTERMID JT,4400112,CDM,521,RC,20605,HCPCS,outpatient,,,303,151.5,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.05,35,,84.84,percent of total billed charges,35% of total billed charges for outpatient setting,236.34,78,,189.072,percent of total billed charges,78% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,251.49,83,,201.192,percent of total billed charges,83% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,151.5,50,,121.2,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.68,39.17,,94.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.05,254.41,
ASPIR OR INJECT SMALL JT/BURSA,4400113,CDM,521,RC,20600,HCPCS,outpatient,,,269,134.5,,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,103.3,38.4,,82.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,103.3,38.4,,82.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,201.75,75,,161.4,percent of total billed charges,75% of total billed charges for outpatient setting,201.75,75,,161.4,percent of total billed charges,75% of total billed charges for outpatient setting,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,201.75,75,,161.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.15,35,,75.32,percent of total billed charges,35% of total billed charges for outpatient setting,209.82,78,,167.856,percent of total billed charges,78% of total billed charges for outpatient setting,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,188.3,70,,150.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,201.75,75,,161.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.27,83,,178.616,percent of total billed charges,83% of total billed charges for outpatient setting,134.5,50,,107.6,percent of total billed charges,50% of total billed charges for outpatient setting,134.5,50,,107.6,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.37,39.17,,84.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.15,254.41,
CLOSED TX METATARSAL FX W MANI,4400114,CDM,360,RC,28475,HCPCS,outpatient,,,706,353,,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,271.1,38.4,,216.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.1,38.4,,216.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,529.5,75,,423.6,percent of total billed charges,75% of total billed charges for outpatient setting,529.5,75,,423.6,percent of total billed charges,75% of total billed charges for outpatient setting,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,529.5,75,,423.6,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.1,35,,197.68,percent of total billed charges,35% of total billed charges for outpatient setting,550.68,78,,440.544,percent of total billed charges,78% of total billed charges for outpatient setting,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,494.2,70,,395.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,529.5,75,,423.6,percent of total billed charges,75% of total billed charges for outpatient setting,585.98,83,,468.784,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,276.52,39.17,,221.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,659,
SHORT LEG CAST,4400115,CDM,360,RC,29405,HCPCS,outpatient,,,235,117.5,,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,90.24,38.4,,72.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.24,38.4,,72.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.25,35,,65.8,percent of total billed charges,35% of total billed charges for outpatient setting,183.3,78,,146.64,percent of total billed charges,78% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,164.5,70,,131.6,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.25,75,,141,percent of total billed charges,75% of total billed charges for outpatient setting,195.05,83,,156.04,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.04,39.17,,73.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.25,659,
TRIGGER PT INJECT S/M 1OR2 MUS,4400116,CDM,521,RC,20552,HCPCS,outpatient,,,747,373.5,,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,286.85,38.4,,229.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,286.85,38.4,,229.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,560.25,75,,448.2,percent of total billed charges,75% of total billed charges for outpatient setting,560.25,75,,448.2,percent of total billed charges,75% of total billed charges for outpatient setting,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,560.25,75,,448.2,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,261.45,35,,209.16,percent of total billed charges,35% of total billed charges for outpatient setting,582.66,78,,466.128,percent of total billed charges,78% of total billed charges for outpatient setting,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,522.9,70,,418.32,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,560.25,75,,448.2,percent of total billed charges,75% of total billed charges for outpatient setting,620.01,83,,496.008,percent of total billed charges,83% of total billed charges for outpatient setting,373.5,50,,298.8,percent of total billed charges,50% of total billed charges for outpatient setting,373.5,50,,298.8,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,292.59,39.17,,234.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,620.01,
TRIGGER PT INJECT S/M 3OR MORE,4400117,CDM,521,RC,20553,HCPCS,outpatient,,,169,84.5,,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.9,38.4,,51.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.15,35,,47.32,percent of total billed charges,35% of total billed charges for outpatient setting,131.82,78,,105.456,percent of total billed charges,78% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,118.3,70,,94.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,126.75,75,,101.4,percent of total billed charges,75% of total billed charges for outpatient setting,140.27,83,,112.216,percent of total billed charges,83% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,84.5,50,,67.6,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.2,39.17,,52.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.15,254.41,
INJ SING TDEON SHEATH OR LIGAM,4400118,CDM,521,RC,20550,HCPCS,outpatient,,,319,159.5,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,35,,89.32,percent of total billed charges,35% of total billed charges for outpatient setting,248.82,78,,199.056,percent of total billed charges,78% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,264.77,83,,211.816,percent of total billed charges,83% of total billed charges for outpatient setting,159.5,50,,127.6,percent of total billed charges,50% of total billed charges for outpatient setting,159.5,50,,127.6,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.95,39.17,,99.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,264.77,
INJ SINGLE TENDON ORIGIN/INSER,4400119,CDM,360,RC,20551,HCPCS,outpatient,,,303,151.5,,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.35,38.4,,93.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.05,35,,84.84,percent of total billed charges,35% of total billed charges for outpatient setting,236.34,78,,189.072,percent of total billed charges,78% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,212.1,70,,169.68,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,227.25,75,,181.8,percent of total billed charges,75% of total billed charges for outpatient setting,251.49,83,,201.192,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.68,39.17,,94.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.05,659,
CORRECTION HAMMERTOE,4400120,CDM,360,RC,28285,HCPCS,outpatient,,,992,496,,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,380.93,38.4,,304.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,380.93,38.4,,304.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,744,75,,595.2,percent of total billed charges,75% of total billed charges for outpatient setting,744,75,,595.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,744,75,,595.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,347.2,35,,277.76,percent of total billed charges,35% of total billed charges for outpatient setting,773.76,78,,619.008,percent of total billed charges,78% of total billed charges for outpatient setting,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,694.4,70,,555.52,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,744,75,,595.2,percent of total billed charges,75% of total billed charges for outpatient setting,823.36,83,,658.688,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,388.55,39.17,,310.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,347.2,3141,
FASCIOTOMY PALMAR OPEN,4400121,CDM,360,RC,26045,HCPCS,outpatient,,,2137,1068.5,,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,820.61,38.4,,656.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,820.61,38.4,,656.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,1602.75,75,,1282.2,percent of total billed charges,75% of total billed charges for outpatient setting,1602.75,75,,1282.2,percent of total billed charges,75% of total billed charges for outpatient setting,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,1602.75,75,,1282.2,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,747.95,35,,598.36,percent of total billed charges,35% of total billed charges for outpatient setting,1666.86,78,,1333.488,percent of total billed charges,78% of total billed charges for outpatient setting,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,1495.9,70,,1196.72,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1602.75,75,,1282.2,percent of total billed charges,75% of total billed charges for outpatient setting,1773.71,83,,1418.968,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,837.02,39.17,,669.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,747.95,3868,
INCISION/DRAIN F.ARM/WRIST ABS,4400122,CDM,360,RC,25028,HCPCS,outpatient,,,1363,681.5,,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,523.39,38.4,,418.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,523.39,38.4,,418.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,477.05,35,,381.64,percent of total billed charges,35% of total billed charges for outpatient setting,1063.14,78,,850.512,percent of total billed charges,78% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,954.1,70,,763.28,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1022.25,75,,817.8,percent of total billed charges,75% of total billed charges for outpatient setting,1131.29,83,,905.032,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,533.86,39.17,,427.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,477.05,3141,
INCIS/DRAIN DEEP ABSCESS THIGH,4400123,CDM,360,RC,27301,HCPCS,outpatient,,,1502,751,,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,576.77,38.4,,461.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,576.77,38.4,,461.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,525.7,35,,420.56,percent of total billed charges,35% of total billed charges for outpatient setting,1171.56,78,,937.248,percent of total billed charges,78% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1246.66,83,,997.328,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,588.31,39.17,,470.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,525.7,3141,
DRAINGAGE OF FINGER ABSCESS,4400124,CDM,360,RC,26011,HCPCS,outpatient,,,876,438,,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,336.38,38.4,,269.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,336.38,38.4,,269.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.6,35,,245.28,percent of total billed charges,35% of total billed charges for outpatient setting,683.28,78,,546.624,percent of total billed charges,78% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,613.2,70,,490.56,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,657,75,,525.6,percent of total billed charges,75% of total billed charges for outpatient setting,727.08,83,,581.664,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,343.11,39.17,,274.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,306.6,2175,
I&D ABSCESS CUTANEOUS/SUBCUTAN,4400125,CDM,360,RC,10061,HCPCS,outpatient,,,451,225.5,,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,173.18,38.4,,138.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.18,38.4,,138.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,338.25,75,,270.6,percent of total billed charges,75% of total billed charges for outpatient setting,338.25,75,,270.6,percent of total billed charges,75% of total billed charges for outpatient setting,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,338.25,75,,270.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.85,35,,126.28,percent of total billed charges,35% of total billed charges for outpatient setting,351.78,78,,281.424,percent of total billed charges,78% of total billed charges for outpatient setting,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,315.7,70,,252.56,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,338.25,75,,270.6,percent of total billed charges,75% of total billed charges for outpatient setting,374.33,83,,299.464,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.64,39.17,,141.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,157.85,659,
REPAIR TENDON MUSCLE UPPER ARM,4400126,CDM,360,RC,24341,HCPCS,outpatient,,,5207,2603.5,,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,35,,1457.96,percent of total billed charges,35% of total billed charges for outpatient setting,4061.46,78,,3249.168,percent of total billed charges,78% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,4321.81,83,,3457.448,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2039.48,39.17,,1631.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,6145.19,
FASCIECTOMY PART PALMAR W/ REL,4400127,CDM,360,RC,26123,HCPCS,outpatient,,,2728,1364,,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1047.55,38.4,,838.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1047.55,38.4,,838.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,2046,75,,1636.8,percent of total billed charges,75% of total billed charges for outpatient setting,2046,75,,1636.8,percent of total billed charges,75% of total billed charges for outpatient setting,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,2046,75,,1636.8,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,954.8,35,,763.84,percent of total billed charges,35% of total billed charges for outpatient setting,2127.84,78,,1702.272,percent of total billed charges,78% of total billed charges for outpatient setting,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,1909.6,70,,1527.68,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2046,75,,1636.8,percent of total billed charges,75% of total billed charges for outpatient setting,2264.24,83,,1811.392,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1068.5,39.17,,854.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,954.8,3868,
REPAIR PRI/PERCUTANEOUS RUPT A,4400128,CDM,360,RC,27650,HCPCS,outpatient,,,2054,1027,,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,788.74,38.4,,630.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,788.74,38.4,,630.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,1540.5,75,,1232.4,percent of total billed charges,75% of total billed charges for outpatient setting,1540.5,75,,1232.4,percent of total billed charges,75% of total billed charges for outpatient setting,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,1540.5,75,,1232.4,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,718.9,35,,575.12,percent of total billed charges,35% of total billed charges for outpatient setting,1602.12,78,,1281.696,percent of total billed charges,78% of total billed charges for outpatient setting,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,1437.8,70,,1150.24,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1540.5,75,,1232.4,percent of total billed charges,75% of total billed charges for outpatient setting,1704.82,83,,1363.856,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,804.51,39.17,,643.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,718.9,6145.19,
CLOSED TX PHALANGEAL FX W/ MAN,4400129,CDM,360,RC,26725,HCPCS,outpatient,,,848,424,,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,325.63,38.4,,260.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,325.63,38.4,,260.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,636,75,,508.8,percent of total billed charges,75% of total billed charges for outpatient setting,636,75,,508.8,percent of total billed charges,75% of total billed charges for outpatient setting,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,636,75,,508.8,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,296.8,35,,237.44,percent of total billed charges,35% of total billed charges for outpatient setting,661.44,78,,529.152,percent of total billed charges,78% of total billed charges for outpatient setting,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,593.6,70,,474.88,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,636,75,,508.8,percent of total billed charges,75% of total billed charges for outpatient setting,703.84,83,,563.072,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,332.14,39.17,,265.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,703.84,
I&D OF ABSCESS SIMPLE OR SINGL,4400130,CDM,360,RC,10060,HCPCS,outpatient,,,257,128.5,,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.95,35,,71.96,percent of total billed charges,35% of total billed charges for outpatient setting,200.46,78,,160.368,percent of total billed charges,78% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,213.31,83,,170.648,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.66,39.17,,80.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.95,659,
SPLIT THICKNESS GRAFT 1ST 100,4400131,CDM,360,RC,15120,HCPCS,outpatient,,,2166,1083,,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,3081.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,831.74,38.4,,665.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,831.74,38.4,,665.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,1624.5,75,,1299.6,percent of total billed charges,75% of total billed charges for outpatient setting,1624.5,75,,1299.6,percent of total billed charges,75% of total billed charges for outpatient setting,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,1624.5,75,,1299.6,percent of total billed charges,75% of total billed charges for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,758.1,35,,606.48,percent of total billed charges,35% of total billed charges for outpatient setting,1689.48,78,,1351.584,percent of total billed charges,78% of total billed charges for outpatient setting,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,1516.2,70,,1212.96,percent of total billed charges,70% of total billed charges for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1624.5,75,,1299.6,percent of total billed charges,75% of total billed charges for outpatient setting,1797.78,83,,1438.224,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,848.37,39.17,,678.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,3081.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,758.1,3868,
AMP METATARSAL W/ TOE SINGLE,4400132,CDM,360,RC,28810,HCPCS,outpatient,,,1285,642.5,,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,493.44,38.4,,394.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,449.75,35,,359.8,percent of total billed charges,35% of total billed charges for outpatient setting,1002.3,78,,801.84,percent of total billed charges,78% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,899.5,70,,719.6,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,963.75,75,,771,percent of total billed charges,75% of total billed charges for outpatient setting,1066.55,83,,853.24,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,503.31,39.17,,402.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,449.75,3141,
I&D DEEP ABSCESS THIGH/KNEE RE,4400133,CDM,360,RC,27301,HCPCS,outpatient,,,1502,751,,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,576.77,38.4,,461.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,576.77,38.4,,461.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,525.7,35,,420.56,percent of total billed charges,35% of total billed charges for outpatient setting,1171.56,78,,937.248,percent of total billed charges,78% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,1051.4,70,,841.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1126.5,75,,901.2,percent of total billed charges,75% of total billed charges for outpatient setting,1246.66,83,,997.328,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,588.31,39.17,,470.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,525.7,3141,
AMPUTATION LEG THROUGH TIB/FIB,4400134,CDM,360,RC,27880,HCPCS,outpatient,,,2582,1291,,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,2582,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,991.49,38.4,,793.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,991.49,38.4,,793.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,1936.5,75,,1549.2,percent of total billed charges,75% of total billed charges for outpatient setting,1936.5,75,,1549.2,percent of total billed charges,75% of total billed charges for outpatient setting,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,1936.5,75,,1549.2,percent of total billed charges,75% of total billed charges for outpatient setting,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,903.7,35,,722.96,percent of total billed charges,35% of total billed charges for outpatient setting,2013.96,78,,1611.168,percent of total billed charges,78% of total billed charges for outpatient setting,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,1807.4,70,,1445.92,percent of total billed charges,70% of total billed charges for outpatient setting,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1936.5,75,,1549.2,percent of total billed charges,75% of total billed charges for outpatient setting,2143.06,83,,1714.448,percent of total billed charges,83% of total billed charges for outpatient setting,6286,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6286,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1011.32,39.17,,809.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2582,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,903.7,6286,
REPAIR EXTENSOR TENDON WO GRAF,4400135,CDM,360,RC,26418,HCPCS,outpatient,,,1746,873,,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,670.46,38.4,,536.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,670.46,38.4,,536.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges for outpatient setting,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges for outpatient setting,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.1,35,,488.88,percent of total billed charges,35% of total billed charges for outpatient setting,1361.88,78,,1089.504,percent of total billed charges,78% of total billed charges for outpatient setting,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1222.2,70,,977.76,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1309.5,75,,1047.6,percent of total billed charges,75% of total billed charges for outpatient setting,1449.18,83,,1159.344,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,683.87,39.17,,547.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,611.1,2175,
REPAIR INTERM WOUND 2.6CM-7.5C,4400136,CDM,360,RC,12042,HCPCS,outpatient,,,511,255.5,,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,35,,143.08,percent of total billed charges,35% of total billed charges for outpatient setting,398.58,78,,318.864,percent of total billed charges,78% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.13,83,,339.304,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,200.14,39.17,,160.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,659,
CLOSED TX SUPRACOND HUMERAL FX,4400137,CDM,360,RC,24535,HCPCS,outpatient,,,1577,788.5,,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,605.57,38.4,,484.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,605.57,38.4,,484.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1182.75,75,,946.2,percent of total billed charges,75% of total billed charges for outpatient setting,1182.75,75,,946.2,percent of total billed charges,75% of total billed charges for outpatient setting,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1182.75,75,,946.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.95,35,,441.56,percent of total billed charges,35% of total billed charges for outpatient setting,1230.06,78,,984.048,percent of total billed charges,78% of total billed charges for outpatient setting,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1103.9,70,,883.12,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1182.75,75,,946.2,percent of total billed charges,75% of total billed charges for outpatient setting,1308.91,83,,1047.128,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,617.68,39.17,,494.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.95,1380.55,
CLOSED TX METACARP DISLOC W/MA,4400138,CDM,360,RC,26705,HCPCS,outpatient,,,942,471,,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,361.73,38.4,,289.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,361.73,38.4,,289.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,329.7,35,,263.76,percent of total billed charges,35% of total billed charges for outpatient setting,734.76,78,,587.808,percent of total billed charges,78% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,659.4,70,,527.52,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,706.5,75,,565.2,percent of total billed charges,75% of total billed charges for outpatient setting,781.86,83,,625.488,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,368.96,39.17,,295.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,329.7,1380.55,
"AMPUTATION THIGH,THROUGH FEMUR",4400139,CDM,360,RC,27590,HCPCS,outpatient,,,2552,1276,,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,2552,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,979.97,38.4,,783.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,979.97,38.4,,783.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,1914,75,,1531.2,percent of total billed charges,75% of total billed charges for outpatient setting,1914,75,,1531.2,percent of total billed charges,75% of total billed charges for outpatient setting,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,1914,75,,1531.2,percent of total billed charges,75% of total billed charges for outpatient setting,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,893.2,35,,714.56,percent of total billed charges,35% of total billed charges for outpatient setting,1990.56,78,,1592.448,percent of total billed charges,78% of total billed charges for outpatient setting,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,1786.4,70,,1429.12,percent of total billed charges,70% of total billed charges for outpatient setting,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1914,75,,1531.2,percent of total billed charges,75% of total billed charges for outpatient setting,2118.16,83,,1694.528,percent of total billed charges,83% of total billed charges for outpatient setting,6286,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6286,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,999.57,39.17,,799.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2552,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,893.2,6286,
EXC. TUMOR SOFT TISSUE 1.5 OR>,4400140,CDM,360,RC,28041,HCPCS,outpatient,,,1166,583,,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,447.74,38.4,,358.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,447.74,38.4,,358.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.1,35,,326.48,percent of total billed charges,35% of total billed charges for outpatient setting,909.48,78,,727.584,percent of total billed charges,78% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,816.2,70,,652.96,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,874.5,75,,699.6,percent of total billed charges,75% of total billed charges for outpatient setting,967.78,83,,774.224,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456.69,39.17,,365.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,408.1,3141,
INJ. ANESTHETIC AGENT/STEROID,4400141,CDM,360,RC,64455,HCPCS,outpatient,,,238,119,,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,91.39,38.4,,73.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91.39,38.4,,73.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,178.5,75,,142.8,percent of total billed charges,75% of total billed charges for outpatient setting,178.5,75,,142.8,percent of total billed charges,75% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,178.5,75,,142.8,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.3,35,,66.64,percent of total billed charges,35% of total billed charges for outpatient setting,185.64,78,,148.512,percent of total billed charges,78% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,166.6,70,,133.28,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.5,75,,142.8,percent of total billed charges,75% of total billed charges for outpatient setting,197.54,83,,158.032,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,93.22,39.17,,74.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,83.3,659,
XFER OR TRANSPLANT SINGLE TEND,4400142,CDM,360,RC,27691,HCPCS,outpatient,,,5207,2603.5,,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1999.49,38.4,,1599.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,35,,1457.96,percent of total billed charges,35% of total billed charges for outpatient setting,4061.46,78,,3249.168,percent of total billed charges,78% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,3644.9,70,,2915.92,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3905.25,75,,3124.2,percent of total billed charges,75% of total billed charges for outpatient setting,4321.81,83,,3457.448,percent of total billed charges,83% of total billed charges for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,4833,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2039.48,39.17,,1631.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1822.45,6145.19,
ARTHRODESIS INTERPHAL JT W/WO,4400143,CDM,360,RC,26860,HCPCS,outpatient,,,1751,875.5,,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,672.38,38.4,,537.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,672.38,38.4,,537.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges for outpatient setting,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges for outpatient setting,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,612.85,35,,490.28,percent of total billed charges,35% of total billed charges for outpatient setting,1365.78,78,,1092.624,percent of total billed charges,78% of total billed charges for outpatient setting,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,1225.7,70,,980.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1313.25,75,,1050.6,percent of total billed charges,75% of total billed charges for outpatient setting,1453.33,83,,1162.664,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,685.83,39.17,,548.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,612.85,3868,
PARING/CUTTING BENIGN LESION S,4400144,CDM,360,RC,11055,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.8,659,
EX/CURETTAGE BONE CYST/TUM/SCA,4400145,CDM,360,RC,23140,HCPCS,outpatient,,,3081,1540.5,,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1183.1,38.4,,946.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1183.1,38.4,,946.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2310.75,75,,1848.6,percent of total billed charges,75% of total billed charges for outpatient setting,2310.75,75,,1848.6,percent of total billed charges,75% of total billed charges for outpatient setting,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2310.75,75,,1848.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1078.35,35,,862.68,percent of total billed charges,35% of total billed charges for outpatient setting,2403.18,78,,1922.544,percent of total billed charges,78% of total billed charges for outpatient setting,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2156.7,70,,1725.36,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2310.75,75,,1848.6,percent of total billed charges,75% of total billed charges for outpatient setting,2557.23,83,,2045.784,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1206.76,39.17,,965.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1078.35,3141,
LENGHTENING TEND/FLEX/HAN/FIN,4400146,CDM,360,RC,26478,HCPCS,outpatient,,,3164,1582,,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,35,,885.92,percent of total billed charges,35% of total billed charges for outpatient setting,2467.92,78,,1974.336,percent of total billed charges,78% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2626.12,83,,2100.896,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1239.28,39.17,,991.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,2780.37,
EX TUMOR SOFT TISSUE OF < 3 CM,4400147,CDM,360,RC,27327,HCPCS,outpatient,,,2356,1178,,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,904.7,38.4,,723.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,904.7,38.4,,723.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1767,75,,1413.6,percent of total billed charges,75% of total billed charges for outpatient setting,1767,75,,1413.6,percent of total billed charges,75% of total billed charges for outpatient setting,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1767,75,,1413.6,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,824.6,35,,659.68,percent of total billed charges,35% of total billed charges for outpatient setting,1837.68,78,,1470.144,percent of total billed charges,78% of total billed charges for outpatient setting,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1649.2,70,,1319.36,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1767,75,,1413.6,percent of total billed charges,75% of total billed charges for outpatient setting,1955.48,83,,1564.384,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,922.79,39.17,,738.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,824.6,3141,
REAMP THIGH THRU FEMUR ANY LEV,4400148,CDM,360,RC,27596,HCPCS,outpatient,,,2383,1191.5,,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,2383,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,915.07,38.4,,732.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.07,38.4,,732.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1787.25,75,,1429.8,percent of total billed charges,75% of total billed charges for outpatient setting,1787.25,75,,1429.8,percent of total billed charges,75% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1787.25,75,,1429.8,percent of total billed charges,75% of total billed charges for outpatient setting,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.05,35,,667.24,percent of total billed charges,35% of total billed charges for outpatient setting,1858.74,78,,1486.992,percent of total billed charges,78% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,1668.1,70,,1334.48,percent of total billed charges,70% of total billed charges for outpatient setting,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1787.25,75,,1429.8,percent of total billed charges,75% of total billed charges for outpatient setting,1977.89,83,,1582.312,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,933.37,39.17,,746.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2383,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,834.05,5560,
CLOSED TX METACARPAL FX SGL W/,4400149,CDM,360,RC,26605,HCPCS,outpatient,,,1085,542.5,,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,416.64,38.4,,333.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,416.64,38.4,,333.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,813.75,75,,651,percent of total billed charges,75% of total billed charges for outpatient setting,813.75,75,,651,percent of total billed charges,75% of total billed charges for outpatient setting,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,813.75,75,,651,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,379.75,35,,303.8,percent of total billed charges,35% of total billed charges for outpatient setting,846.3,78,,677.04,percent of total billed charges,78% of total billed charges for outpatient setting,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,759.5,70,,607.6,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,813.75,75,,651,percent of total billed charges,75% of total billed charges for outpatient setting,900.55,83,,720.44,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,424.97,39.17,,339.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,900.55,
PERCUTANEOUS SKEL FIX METACARP,4400150,CDM,360,RC,26608,HCPCS,outpatient,,,3164,1582,,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1214.98,38.4,,971.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,35,,885.92,percent of total billed charges,35% of total billed charges for outpatient setting,2467.92,78,,1974.336,percent of total billed charges,78% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2214.8,70,,1771.84,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2373,75,,1898.4,percent of total billed charges,75% of total billed charges for outpatient setting,2626.12,83,,2100.896,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1239.28,39.17,,991.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1107.4,3141,
CL'D TX SUPRACOND FEMOR FX WO,4400151,CDM,360,RC,27501,HCPCS,outpatient,,,1632,816,,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,626.69,38.4,,501.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,626.69,38.4,,501.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,1224,75,,979.2,percent of total billed charges,75% of total billed charges for outpatient setting,1224,75,,979.2,percent of total billed charges,75% of total billed charges for outpatient setting,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,1224,75,,979.2,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,571.2,35,,456.96,percent of total billed charges,35% of total billed charges for outpatient setting,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges for outpatient setting,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,1142.4,70,,913.92,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1224,75,,979.2,percent of total billed charges,75% of total billed charges for outpatient setting,1354.56,83,,1083.648,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,639.22,39.17,,511.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,1354.56,
I&D BLOW FASCIA FOOT SLG BURSA,4400152,CDM,360,RC,28002,HCPCS,outpatient,,,911,455.5,,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,349.82,38.4,,279.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,349.82,38.4,,279.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,683.25,75,,546.6,percent of total billed charges,75% of total billed charges for outpatient setting,683.25,75,,546.6,percent of total billed charges,75% of total billed charges for outpatient setting,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,683.25,75,,546.6,percent of total billed charges,75% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.85,35,,255.08,percent of total billed charges,35% of total billed charges for outpatient setting,710.58,78,,568.464,percent of total billed charges,78% of total billed charges for outpatient setting,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,637.7,70,,510.16,percent of total billed charges,70% of total billed charges for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,683.25,75,,546.6,percent of total billed charges,75% of total billed charges for outpatient setting,756.13,83,,604.904,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,356.82,39.17,,285.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1380.55,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,318.85,3141,
REMOVAL FOREIGN BODY FOOT SUBC,4400153,CDM,360,RC,28190,HCPCS,outpatient,,,511,255.5,,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,35,,143.08,percent of total billed charges,35% of total billed charges for outpatient setting,398.58,78,,318.864,percent of total billed charges,78% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.13,83,,339.304,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,200.14,39.17,,160.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.85,1452,
EX NAIL/NAIL MATRIX PARTICAL C,4400154,CDM,360,RC,11752,HCPCS,outpatient,,,1234,617,,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,473.86,38.4,,379.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,473.86,38.4,,379.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,925.5,75,,740.4,percent of total billed charges,75% of total billed charges for outpatient setting,925.5,75,,740.4,percent of total billed charges,75% of total billed charges for outpatient setting,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,925.5,75,,740.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,431.9,35,,345.52,percent of total billed charges,35% of total billed charges for outpatient setting,962.52,78,,770.016,percent of total billed charges,78% of total billed charges for outpatient setting,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,863.8,70,,691.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,925.5,75,,740.4,percent of total billed charges,75% of total billed charges for outpatient setting,1024.22,83,,819.376,percent of total billed charges,83% of total billed charges for outpatient setting,617,50,,493.6,percent of total billed charges,50% of total billed charges for outpatient setting,617,50,,493.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.34,39.17,,386.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,431.9,1024.22,
AVULSION NAIL PLATE PCS EC ADD,4400155,CDM,360,RC,11732,HCPCS,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,35,,21,percent of total billed charges,35% of total billed charges for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.38,39.17,,23.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.25,659,
EX TUMOR SOFT TISSUE 3CM OR >,4400156,CDM,360,RC,27337,HCPCS,outpatient,,,1200,600,,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,460.8,38.4,,368.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,420,35,,336,percent of total billed charges,35% of total billed charges for outpatient setting,936,78,,748.8,percent of total billed charges,78% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,840,70,,672,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,900,75,,720,percent of total billed charges,75% of total billed charges for outpatient setting,996,83,,796.8,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,470.02,39.17,,376.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,420,3141,
EX TUMOR SOFT TISSUE 1.5CM OR>,4400157,CDM,360,RC,28039,HCPCS,outpatient,,,1177,588.5,,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,451.97,38.4,,361.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,451.97,38.4,,361.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,882.75,75,,706.2,percent of total billed charges,75% of total billed charges for outpatient setting,882.75,75,,706.2,percent of total billed charges,75% of total billed charges for outpatient setting,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,882.75,75,,706.2,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,411.95,35,,329.56,percent of total billed charges,35% of total billed charges for outpatient setting,918.06,78,,734.448,percent of total billed charges,78% of total billed charges for outpatient setting,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,823.9,70,,659.12,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,882.75,75,,706.2,percent of total billed charges,75% of total billed charges for outpatient setting,976.91,83,,781.528,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,461.01,39.17,,368.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,411.95,3141,
OSTECTOMY PARTIAL EXC BUNIONET,4400158,CDM,360,RC,28110,HCPCS,outpatient,,,2301,1150.5,,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,883.58,38.4,,706.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,805.35,35,,644.28,percent of total billed charges,35% of total billed charges for outpatient setting,1794.78,78,,1435.824,percent of total billed charges,78% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,1610.7,70,,1288.56,percent of total billed charges,70% of total billed charges for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1725.75,75,,1380.6,percent of total billed charges,75% of total billed charges for outpatient setting,1909.83,83,,1527.864,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,901.25,39.17,,721,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2780.37,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,805.35,3141,
SIMPLE REPAIR SUPER WOUND 2.5<,4400159,CDM,360,RC,12001,HCPCS,outpatient,,,318,159,,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.11,38.4,,97.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.11,38.4,,97.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.3,35,,89.04,percent of total billed charges,35% of total billed charges for outpatient setting,248.04,78,,198.432,percent of total billed charges,78% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,263.94,83,,211.152,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.55,39.17,,99.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.3,659,
OPEN TX ACROMIOCLAVICUR DISLOC,4400161,CDM,360,RC,23550,HCPCS,outpatient,,,1964,982,,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,754.18,38.4,,603.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,754.18,38.4,,603.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,1473,75,,1178.4,percent of total billed charges,75% of total billed charges for outpatient setting,1473,75,,1178.4,percent of total billed charges,75% of total billed charges for outpatient setting,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,1473,75,,1178.4,percent of total billed charges,75% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.4,35,,549.92,percent of total billed charges,35% of total billed charges for outpatient setting,1531.92,78,,1225.536,percent of total billed charges,78% of total billed charges for outpatient setting,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,1374.8,70,,1099.84,percent of total billed charges,70% of total billed charges for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1473,75,,1178.4,percent of total billed charges,75% of total billed charges for outpatient setting,1630.12,83,,1304.096,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,769.26,39.17,,615.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,6145.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,687.4,6145.19,
CLOSED TX METACARPAL FX W/O MA,4400162,CDM,360,RC,26600,HCPCS,outpatient,,,681,340.5,,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,261.5,38.4,,209.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.35,35,,190.68,percent of total billed charges,35% of total billed charges for outpatient setting,531.18,78,,424.944,percent of total billed charges,78% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,476.7,70,,381.36,percent of total billed charges,70% of total billed charges for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,510.75,75,,408.6,percent of total billed charges,75% of total billed charges for outpatient setting,565.23,83,,452.184,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,266.73,39.17,,213.384,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,202.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,202.56,659,
E&M NEW VISIT (BRIEF),6000000,CDM,761,RC,99201,HCPCS,outpatient,,,135,67.5,,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.84,38.4,,41.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,35,,37.8,percent of total billed charges,35% of total billed charges for outpatient setting,105.3,78,,84.24,percent of total billed charges,78% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,70,,75.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.25,75,,81,percent of total billed charges,75% of total billed charges for outpatient setting,112.05,83,,89.64,percent of total billed charges,83% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,67.5,50,,54,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.88,39.17,,42.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,47.25,112.05,
E&M NEW PT VISIT LIMITED,6000001,CDM,761,RC,99202,HCPCS,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.9,35,,54.32,percent of total billed charges,35% of total billed charges for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.99,39.17,,60.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.9,161.02,
E&M NEW PT VISIT INTERMEDIATE,6000002,CDM,761,RC,99203,HCPCS,outpatient,,,257,128.5,,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.69,38.4,,78.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.95,35,,71.96,percent of total billed charges,35% of total billed charges for outpatient setting,200.46,78,,160.368,percent of total billed charges,78% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,179.9,70,,143.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192.75,75,,154.2,percent of total billed charges,75% of total billed charges for outpatient setting,213.31,83,,170.648,percent of total billed charges,83% of total billed charges for outpatient setting,128.5,50,,102.8,percent of total billed charges,50% of total billed charges for outpatient setting,128.5,50,,102.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.66,39.17,,80.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,89.95,213.31,
E&M NEW PT VISIT EXTENDED,6000003,CDM,761,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
E&M NEW PT VISIT COMPLEX,6000004,CDM,761,RC,99205,HCPCS,outpatient,,,435,217.5,,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,167.04,38.4,,133.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.04,38.4,,133.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.25,35,,121.8,percent of total billed charges,35% of total billed charges for outpatient setting,339.3,78,,271.44,percent of total billed charges,78% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,304.5,70,,243.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,326.25,75,,261,percent of total billed charges,75% of total billed charges for outpatient setting,361.05,83,,288.84,percent of total billed charges,83% of total billed charges for outpatient setting,217.5,50,,174,percent of total billed charges,50% of total billed charges for outpatient setting,217.5,50,,174,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.38,39.17,,136.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,152.25,361.05,
E&M ESTABLISHED PT VISIT BRIEF,6000005,CDM,761,RC,99211,HCPCS,outpatient,,,57.39,28.7,,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.04,38.4,,17.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.04,38.4,,17.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,43.04,75,,34.432,percent of total billed charges,75% of total billed charges for outpatient setting,43.04,75,,34.432,percent of total billed charges,75% of total billed charges for outpatient setting,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,43.04,75,,34.432,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.09,35,,16.072,percent of total billed charges,35% of total billed charges for outpatient setting,44.76,78,,35.808,percent of total billed charges,78% of total billed charges for outpatient setting,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,40.17,70,,32.136,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.04,75,,34.432,percent of total billed charges,75% of total billed charges for outpatient setting,47.63,83,,38.104,percent of total billed charges,83% of total billed charges for outpatient setting,28.7,50,,22.96,percent of total billed charges,50% of total billed charges for outpatient setting,28.7,50,,22.96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.48,39.17,,17.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.09,47.63,
E&M ESTABLISHED PT VISIT LIMIT,6000006,CDM,761,RC,G0463,HCPCS,outpatient,,,194,97,,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.5,38.4,,59.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.9,35,,54.32,percent of total billed charges,35% of total billed charges for outpatient setting,151.32,78,,121.056,percent of total billed charges,78% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,135.8,70,,108.64,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,145.5,75,,116.4,percent of total billed charges,75% of total billed charges for outpatient setting,161.02,83,,128.816,percent of total billed charges,83% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,97,50,,77.6,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.99,39.17,,60.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.9,161.02,
E&M ESTABLISHED PT VISIT INTER,6000007,CDM,761,RC,G0463,HCPCS,outpatient,,,163.74,81.87,,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.88,38.4,,50.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.88,38.4,,50.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,122.81,75,,98.248,percent of total billed charges,75% of total billed charges for outpatient setting,122.81,75,,98.248,percent of total billed charges,75% of total billed charges for outpatient setting,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,122.81,75,,98.248,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.31,35,,45.848,percent of total billed charges,35% of total billed charges for outpatient setting,127.72,78,,102.176,percent of total billed charges,78% of total billed charges for outpatient setting,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,114.62,70,,91.696,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.81,75,,98.248,percent of total billed charges,75% of total billed charges for outpatient setting,135.9,83,,108.72,percent of total billed charges,83% of total billed charges for outpatient setting,81.87,50,,65.496,percent of total billed charges,50% of total billed charges for outpatient setting,81.87,50,,65.496,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.14,39.17,,51.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.31,135.9,
E&M ESTABLISHED PT VISIT EXTEN,6000008,CDM,761,RC,G0463,HCPCS,outpatient,,,216.91,108.46,,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,83.29,38.4,,66.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.29,38.4,,66.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,162.68,75,,130.144,percent of total billed charges,75% of total billed charges for outpatient setting,162.68,75,,130.144,percent of total billed charges,75% of total billed charges for outpatient setting,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,162.68,75,,130.144,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.92,35,,60.736,percent of total billed charges,35% of total billed charges for outpatient setting,169.19,78,,135.352,percent of total billed charges,78% of total billed charges for outpatient setting,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,151.84,70,,121.472,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162.68,75,,130.144,percent of total billed charges,75% of total billed charges for outpatient setting,180.04,83,,144.032,percent of total billed charges,83% of total billed charges for outpatient setting,108.46,50,,86.768,percent of total billed charges,50% of total billed charges for outpatient setting,108.46,50,,86.768,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.96,39.17,,67.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.92,180.04,
E&M ESTABLISHED PT VISIT COMPL,6000009,CDM,761,RC,G0463,HCPCS,outpatient,,,331,165.5,,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.85,35,,92.68,percent of total billed charges,35% of total billed charges for outpatient setting,258.18,78,,206.544,percent of total billed charges,78% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,274.73,83,,219.784,percent of total billed charges,83% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,129.64,39.17,,103.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,274.73,
DEBRIDEMENT SUBQ (1ST 20SQ CM),6000010,CDM,761,RC,11042,HCPCS,outpatient,,,328.3,164.15,,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.07,38.4,,100.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.07,38.4,,100.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,246.23,75,,196.984,percent of total billed charges,75% of total billed charges for outpatient setting,246.23,75,,196.984,percent of total billed charges,75% of total billed charges for outpatient setting,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,246.23,75,,196.984,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.91,35,,91.928,percent of total billed charges,35% of total billed charges for outpatient setting,256.07,78,,204.856,percent of total billed charges,78% of total billed charges for outpatient setting,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,229.81,70,,183.848,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.23,75,,196.984,percent of total billed charges,75% of total billed charges for outpatient setting,272.49,83,,217.992,percent of total billed charges,83% of total billed charges for outpatient setting,164.15,50,,131.32,percent of total billed charges,50% of total billed charges for outpatient setting,164.15,50,,131.32,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.59,39.17,,102.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.91,342.51,
DEBRIDEMENT SUBQ ADD'L 20SQ CM,6000011,CDM,761,RC,11045,HCPCS,outpatient,,,397,198.5,,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.45,38.4,,121.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.45,38.4,,121.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,297.75,75,,238.2,percent of total billed charges,75% of total billed charges for outpatient setting,297.75,75,,238.2,percent of total billed charges,75% of total billed charges for outpatient setting,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,297.75,75,,238.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.95,35,,111.16,percent of total billed charges,35% of total billed charges for outpatient setting,309.66,78,,247.728,percent of total billed charges,78% of total billed charges for outpatient setting,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,277.9,70,,222.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,297.75,75,,238.2,percent of total billed charges,75% of total billed charges for outpatient setting,329.51,83,,263.608,percent of total billed charges,83% of total billed charges for outpatient setting,198.5,50,,158.8,percent of total billed charges,50% of total billed charges for outpatient setting,198.5,50,,158.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.5,39.17,,124.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,138.95,329.51,
DEBR MUSCLE/FASCIA 1ST 20SQ C,6000012,CDM,761,RC,11043,HCPCS,outpatient,,,932,466,,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,357.89,38.4,,286.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.89,38.4,,286.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,699,75,,559.2,percent of total billed charges,75% of total billed charges for outpatient setting,699,75,,559.2,percent of total billed charges,75% of total billed charges for outpatient setting,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,699,75,,559.2,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,326.2,35,,260.96,percent of total billed charges,35% of total billed charges for outpatient setting,726.96,78,,581.568,percent of total billed charges,78% of total billed charges for outpatient setting,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,652.4,70,,521.92,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,699,75,,559.2,percent of total billed charges,75% of total billed charges for outpatient setting,773.56,83,,618.848,percent of total billed charges,83% of total billed charges for outpatient setting,466,50,,372.8,percent of total billed charges,50% of total billed charges for outpatient setting,466,50,,372.8,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,365.05,39.17,,292.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,326.2,773.56,
DEBR MUSCLE/FASCIA 1ST 20SQ C,6000013,CDM,761,RC,11046,HCPCS,outpatient,,,793,396.5,,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,304.51,38.4,,243.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,304.51,38.4,,243.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,594.75,75,,475.8,percent of total billed charges,75% of total billed charges for outpatient setting,594.75,75,,475.8,percent of total billed charges,75% of total billed charges for outpatient setting,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,594.75,75,,475.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.55,35,,222.04,percent of total billed charges,35% of total billed charges for outpatient setting,618.54,78,,494.832,percent of total billed charges,78% of total billed charges for outpatient setting,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,555.1,70,,444.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,594.75,75,,475.8,percent of total billed charges,75% of total billed charges for outpatient setting,658.19,83,,526.552,percent of total billed charges,83% of total billed charges for outpatient setting,396.5,50,,317.2,percent of total billed charges,50% of total billed charges for outpatient setting,396.5,50,,317.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,310.6,39.17,,248.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,277.55,658.19,
DEBR BONE (1ST 20SQ CM),6000014,CDM,761,RC,11044,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,660,50,,528,percent of total billed charges,50% of total billed charges for outpatient setting,660,50,,528,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,462,1392.65,
DEBR BONE (ADD'L 20SQ CM),6000015,CDM,761,RC,11047,HCPCS,outpatient,,,1320,660,,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,506.88,38.4,,405.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,462,35,,369.6,percent of total billed charges,35% of total billed charges for outpatient setting,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,924,70,,739.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,990,75,,792,percent of total billed charges,75% of total billed charges for outpatient setting,1095.6,83,,876.48,percent of total billed charges,83% of total billed charges for outpatient setting,660,50,,528,percent of total billed charges,50% of total billed charges for outpatient setting,660,50,,528,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,517.02,39.17,,413.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,462,1095.6,
SELECTIVE DEBR  (1ST 20SQ CM),6000016,CDM,761,RC,97597,HCPCS,outpatient,,,158.91,79.46,,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,61.02,38.4,,48.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.02,38.4,,48.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,119.18,75,,95.344,percent of total billed charges,75% of total billed charges for outpatient setting,119.18,75,,95.344,percent of total billed charges,75% of total billed charges for outpatient setting,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,119.18,75,,95.344,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.62,35,,44.496,percent of total billed charges,35% of total billed charges for outpatient setting,123.95,78,,99.16,percent of total billed charges,78% of total billed charges for outpatient setting,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,111.24,70,,88.992,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,119.18,75,,95.344,percent of total billed charges,75% of total billed charges for outpatient setting,131.9,83,,105.52,percent of total billed charges,83% of total billed charges for outpatient setting,79.46,50,,63.568,percent of total billed charges,50% of total billed charges for outpatient setting,79.46,50,,63.568,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.24,39.17,,49.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.62,171.96,
SELECTIVE DEBR  (1ST 20SQ CM),6000017,CDM,761,RC,97598,HCPCS,outpatient,,,153,76.5,,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.55,35,,42.84,percent of total billed charges,35% of total billed charges for outpatient setting,119.34,78,,95.472,percent of total billed charges,78% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,126.99,83,,101.592,percent of total billed charges,83% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.93,39.17,,47.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.55,126.99,
WOUND CAUTERY CHEMICAL,6000018,CDM,761,RC,17250,HCPCS,outpatient,,,638,319,,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,244.99,38.4,,195.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,244.99,38.4,,195.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,223.3,35,,178.64,percent of total billed charges,35% of total billed charges for outpatient setting,497.64,78,,398.112,percent of total billed charges,78% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,446.6,70,,357.28,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,478.5,75,,382.8,percent of total billed charges,75% of total billed charges for outpatient setting,529.54,83,,423.632,percent of total billed charges,83% of total billed charges for outpatient setting,319,50,,255.2,percent of total billed charges,50% of total billed charges for outpatient setting,319,50,,255.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,249.89,39.17,,199.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,529.54,
BIOPSY SINGLE LESION,6000019,CDM,761,RC,11100,HCPCS,outpatient,,,304,152,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.4,35,,85.12,percent of total billed charges,35% of total billed charges for outpatient setting,237.12,78,,189.696,percent of total billed charges,78% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,252.32,83,,201.856,percent of total billed charges,83% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.07,39.17,,95.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,106.4,252.32,
BIOPSY ADD'L LESION,6000020,CDM,761,RC,11101,HCPCS,outpatient,,,304,152,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.4,35,,85.12,percent of total billed charges,35% of total billed charges for outpatient setting,237.12,78,,189.696,percent of total billed charges,78% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,252.32,83,,201.856,percent of total billed charges,83% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.07,39.17,,95.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,106.4,252.32,
NEGATIVE PRESSURE (<50SQ CM),6000021,CDM,761,RC,97605,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,171.96,
NEGATIVE PRESSURE (>50SQ CM),6000022,CDM,761,RC,97606,HCPCS,outpatient,,,153,76.5,,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,35,,42.84,percent of total billed charges,35% of total billed charges for outpatient setting,119.34,78,,95.472,percent of total billed charges,78% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,126.99,83,,101.592,percent of total billed charges,83% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.93,39.17,,47.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,342.51,
I&D ABCESS,6000023,CDM,761,RC,10060,HCPCS,outpatient,,,243,121.5,,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.05,35,,68.04,percent of total billed charges,35% of total billed charges for outpatient setting,189.54,78,,151.632,percent of total billed charges,78% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.69,83,,161.352,percent of total billed charges,83% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.18,39.17,,76.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.05,201.69,
APPLICATION SKIN SUBSTITUTE GR,6000024,CDM,761,RC,15275,HCPCS,outpatient,,,2822,1411,,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1083.65,38.4,,866.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1083.65,38.4,,866.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.7,35,,790.16,percent of total billed charges,35% of total billed charges for outpatient setting,2201.16,78,,1760.928,percent of total billed charges,78% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1975.4,70,,1580.32,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2116.5,75,,1693.2,percent of total billed charges,75% of total billed charges for outpatient setting,2342.26,83,,1873.808,percent of total billed charges,83% of total billed charges for outpatient setting,1411,50,,1128.8,percent of total billed charges,50% of total billed charges for outpatient setting,1411,50,,1128.8,percent of total billed charges,50% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1105.32,39.17,,884.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,987.7,2342.26,
APPLICATION SKIN SUBSTITUTE GR,6000025,CDM,761,RC,15271,HCPCS,outpatient,,,4287.5,2143.75,,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1646.4,38.4,,1317.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1646.4,38.4,,1317.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,3215.63,75,,2572.504,percent of total billed charges,75% of total billed charges for outpatient setting,3215.63,75,,2572.504,percent of total billed charges,75% of total billed charges for outpatient setting,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,3215.63,75,,2572.504,percent of total billed charges,75% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1500.63,35,,1200.504,percent of total billed charges,35% of total billed charges for outpatient setting,3344.25,78,,2675.4,percent of total billed charges,78% of total billed charges for outpatient setting,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,3001.25,70,,2401,percent of total billed charges,70% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3215.63,75,,2572.504,percent of total billed charges,75% of total billed charges for outpatient setting,3558.63,83,,2846.904,percent of total billed charges,83% of total billed charges for outpatient setting,2143.75,50,,1715,percent of total billed charges,50% of total billed charges for outpatient setting,2143.75,50,,1715,percent of total billed charges,50% of total billed charges for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1679.33,39.17,,1343.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1566.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1500.63,3558.63,
EPIFIX PRODUCT (PER UNIT),6000026,CDM,761,RC,Q4131,HCPCS,outpatient,,,452,226,,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.57,38.4,,138.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,173.57,38.4,,138.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,339,75,,271.2,percent of total billed charges,75% of total billed charges for outpatient setting,339,75,,271.2,percent of total billed charges,75% of total billed charges for outpatient setting,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,339,75,,271.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.2,35,,126.56,percent of total billed charges,35% of total billed charges for outpatient setting,352.56,78,,282.048,percent of total billed charges,78% of total billed charges for outpatient setting,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,316.4,70,,253.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339,75,,271.2,percent of total billed charges,75% of total billed charges for outpatient setting,375.16,83,,300.128,percent of total billed charges,83% of total billed charges for outpatient setting,226,50,,180.8,percent of total billed charges,50% of total billed charges for outpatient setting,226,50,,180.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,177.04,39.17,,141.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,158.2,375.16,
EXC NONDYSTROPHIC NAIL ANY NBR,6000027,CDM,761,RC,11719,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,104.58,
DEBRIDEMENT OF NAIL(S) 1-5,6000028,CDM,761,RC,11720,HCPCS,outpatient,,,264,132,,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,101.38,38.4,,81.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.38,38.4,,81.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.4,35,,73.92,percent of total billed charges,35% of total billed charges for outpatient setting,205.92,78,,164.736,percent of total billed charges,78% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,184.8,70,,147.84,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,198,75,,158.4,percent of total billed charges,75% of total billed charges for outpatient setting,219.12,83,,175.296,percent of total billed charges,83% of total billed charges for outpatient setting,132,50,,105.6,percent of total billed charges,50% of total billed charges for outpatient setting,132,50,,105.6,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.41,39.17,,82.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,219.12,
DEBR OF NAIL(S) 6 OR MORE,6000029,CDM,761,RC,11721,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,104.58,
AVUL OF NAIL PLATE PAR COM SIN,6000030,CDM,761,RC,11730,HCPCS,outpatient,,,153,76.5,,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.75,38.4,,47,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,35,,42.84,percent of total billed charges,35% of total billed charges for outpatient setting,119.34,78,,95.472,percent of total billed charges,78% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,107.1,70,,85.68,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.75,75,,91.8,percent of total billed charges,75% of total billed charges for outpatient setting,126.99,83,,101.592,percent of total billed charges,83% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,76.5,50,,61.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.93,39.17,,47.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.55,171.96,
AVUL NAIL PTE PAR COM SIN ADD',6000031,CDM,761,RC,11732,HCPCS,outpatient,,,304,152,,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.74,38.4,,93.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.4,35,,85.12,percent of total billed charges,35% of total billed charges for outpatient setting,237.12,78,,189.696,percent of total billed charges,78% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,212.8,70,,170.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228,75,,182.4,percent of total billed charges,75% of total billed charges for outpatient setting,252.32,83,,201.856,percent of total billed charges,83% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,152,50,,121.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.07,39.17,,95.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,106.4,252.32,
EVACUATION OF SUBUNGUAL HEMATO,6000032,CDM,761,RC,11740,HCPCS,outpatient,,,126,63,,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48.38,38.4,,38.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,35,,35.28,percent of total billed charges,35% of total billed charges for outpatient setting,98.28,78,,78.624,percent of total billed charges,78% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,88.2,70,,70.56,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.5,75,,75.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.58,83,,83.664,percent of total billed charges,83% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,63,50,,50.4,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,39.17,,39.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.1,109.72,
BIOPSY OF NAIL UNIT,6000033,CDM,761,RC,11755,HCPCS,outpatient,,,657,328.5,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,35,,183.96,percent of total billed charges,35% of total billed charges for outpatient setting,512.46,78,,409.968,percent of total billed charges,78% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,545.31,83,,436.248,percent of total billed charges,83% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.34,39.17,,205.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,604.35,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,604.35,
WEDGE EXC OF SKIN OF NAIL FOLD,6000034,CDM,761,RC,11765,HCPCS,outpatient,,,236,118,,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.62,38.4,,72.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.6,35,,66.08,percent of total billed charges,35% of total billed charges for outpatient setting,184.08,78,,147.264,percent of total billed charges,78% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,165.2,70,,132.16,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,177,75,,141.6,percent of total billed charges,75% of total billed charges for outpatient setting,195.88,83,,156.704,percent of total billed charges,83% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,118,50,,94.4,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.43,39.17,,73.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.6,342.51,
EXC OF NAIL &NAIL MATRIX,6000035,CDM,761,RC,11750,HCPCS,outpatient,,,657,328.5,,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,252.29,38.4,,201.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,35,,183.96,percent of total billed charges,35% of total billed charges for outpatient setting,512.46,78,,409.968,percent of total billed charges,78% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,459.9,70,,367.92,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,492.75,75,,394.2,percent of total billed charges,75% of total billed charges for outpatient setting,545.31,83,,436.248,percent of total billed charges,83% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,328.5,50,,262.8,percent of total billed charges,50% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,257.34,39.17,,205.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,229.95,545.31,
WOUND CARE ORDER,6000036,CDM,420,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
CANCEL WOUND CARE,6000037,CDM,420,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
TOTAL CONTACT CAST,6000038,CDM,761,RC,29445,HCPCS,outpatient,,,1178,589,,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,452.35,38.4,,361.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,452.35,38.4,,361.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,883.5,75,,706.8,percent of total billed charges,75% of total billed charges for outpatient setting,883.5,75,,706.8,percent of total billed charges,75% of total billed charges for outpatient setting,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,883.5,75,,706.8,percent of total billed charges,75% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,412.3,35,,329.84,percent of total billed charges,35% of total billed charges for outpatient setting,918.84,78,,735.072,percent of total billed charges,78% of total billed charges for outpatient setting,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,824.6,70,,659.68,percent of total billed charges,70% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,883.5,75,,706.8,percent of total billed charges,75% of total billed charges for outpatient setting,977.74,83,,782.192,percent of total billed charges,83% of total billed charges for outpatient setting,589,50,,471.2,percent of total billed charges,50% of total billed charges for outpatient setting,589,50,,471.2,percent of total billed charges,50% of total billed charges for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,461.4,39.17,,369.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,230.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,230.68,977.74,
"EPIFIX, PER SQ CM",6000039,CDM,761,RC,Q4186,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
I&D HEMATOMA,6000040,CDM,761,RC,10140,HCPCS,outpatient,,,820,410,,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,314.88,38.4,,251.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,314.88,38.4,,251.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,615,75,,492,percent of total billed charges,75% of total billed charges for outpatient setting,615,75,,492,percent of total billed charges,75% of total billed charges for outpatient setting,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,615,75,,492,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,287,35,,229.6,percent of total billed charges,35% of total billed charges for outpatient setting,639.6,78,,511.68,percent of total billed charges,78% of total billed charges for outpatient setting,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,574,70,,459.2,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,615,75,,492,percent of total billed charges,75% of total billed charges for outpatient setting,680.6,83,,544.48,percent of total billed charges,83% of total billed charges for outpatient setting,410,50,,328,percent of total billed charges,50% of total billed charges for outpatient setting,410,50,,328,percent of total billed charges,50% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,321.18,39.17,,256.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,287,1392.65,
LOW CAST SKIN SUB APP 1ST 25CM,6000041,CDM,761,RC,C5271,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.5,539.48,
LOW CAST SKIN SUB APP EACH ADD 25CM,6000042,CDM,761,RC,C5272,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
CLINIC VISIT,6200000,CDM,510,RC,G0463,HCPCS,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.85,35,,53.48,percent of total billed charges,35% of total billed charges for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.81,39.17,,59.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,113.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.85,158.53,
BREAST CLINIC EST PATIENT,6200002,CDM,510,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
IV INFUSION 1 HOUR,6300000,CDM,510,RC,96365,HCPCS,outpatient,,,165,82.5,,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,35,,46.2,percent of total billed charges,35% of total billed charges for outpatient setting,128.7,78,,102.96,percent of total billed charges,78% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,136.95,83,,109.56,percent of total billed charges,83% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.63,39.17,,51.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,184.11,
TREATMENT SWALLOWING/ORAL/FEED,6392526,CDM,440,RC,92526,HCPCS,outpatient,,,216,108,,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,82.94,38.4,,66.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.94,38.4,,66.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,35,,60.48,percent of total billed charges,35% of total billed charges for outpatient setting,168.48,78,,134.784,percent of total billed charges,78% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,151.2,70,,120.96,percent of total billed charges,70% of total billed charges for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,162,75,,129.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.28,83,,143.424,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.6,39.17,,67.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,75.6,424,
EVAL FOR SWALLOWING/ORAL/PHARY,6392610,CDM,440,RC,92610,HCPCS,outpatient,,,222,111,,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,85.25,38.4,,68.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.25,38.4,,68.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.7,35,,62.16,percent of total billed charges,35% of total billed charges for outpatient setting,173.16,78,,138.528,percent of total billed charges,78% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.26,83,,147.408,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,86.96,39.17,,69.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,424,
GENERAL EVAL/ PARTIAL PT,6397001,CDM,424,RC,97001,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,424,
RE-EVALUATION PT,6397002,CDM,424,RC,97002,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,424,
GENERAL EVALUATION OT,6397003,CDM,434,RC,97003,HCPCS,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,424,
WHIRPOOL,6397022,CDM,421,RC,97022,HCPCS,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,424,
ULTRASOUND/PER 15 MIN,6397035,CDM,421,RC,97035,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
EXERCISE/PER 15 MIN,6397110,CDM,421,RC,97110,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,424,
NEURO MUSCULAR RE-ED/PER 15 MI,6397112,CDM,421,RC,97112,HCPCS,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.3,424,
GAIT TRAINING,6397116,CDM,421,RC,97116,HCPCS,outpatient,,,70,35,,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.88,38.4,,21.504,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,35,,19.6,percent of total billed charges,35% of total billed charges for outpatient setting,54.6,78,,43.68,percent of total billed charges,78% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,49,70,,39.2,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.5,75,,42,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,83,,46.48,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.42,39.17,,21.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.5,424,
MASSAGE / PER 15MIN,6397124,CDM,421,RC,97124,HCPCS,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,27.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.1,424,
TRANSFER TRAIN/PER 15 MIN,6397530,CDM,421,RC,97530,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,424,
SELF CARE MGT/15 MIN,6397535,CDM,431,RC,97535,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,424,
WHEELCHAIR MANAGEMENT/PER 15 M,6397542,CDM,431,RC,97542,HCPCS,outpatient,,,77,38.5,,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.57,38.4,,23.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.95,35,,21.56,percent of total billed charges,35% of total billed charges for outpatient setting,60.06,78,,48.048,percent of total billed charges,78% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,53.9,70,,43.12,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,75,,46.2,percent of total billed charges,75% of total billed charges for outpatient setting,63.91,83,,51.128,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.16,39.17,,24.128,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.95,424,
ORTHO FIT/TRAIN/PER 15 MIN,6397760,CDM,421,RC,97760,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,424,
THERAPEUTIC EXERCISE/PER 15 MI,6398110,CDM,431,RC,97110,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,424,
NEURO MUSCULAR RE-ED,6398112,CDM,431,RC,97112,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,424,
ORTHO FIT/TRAIN/PER 15 MIN,6398760,CDM,431,RC,97760,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,424,
DRESS,6399201,CDM,510,RC,99201,HCPCS,outpatient,,,160,80,,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.44,38.4,,49.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56,35,,44.8,percent of total billed charges,35% of total billed charges for outpatient setting,124.8,78,,99.84,percent of total billed charges,78% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,112,70,,89.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120,75,,96,percent of total billed charges,75% of total billed charges for outpatient setting,132.8,83,,106.24,percent of total billed charges,83% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,80,50,,64,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.67,39.17,,50.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,56,132.8,
NEW OUTPATIENT LEVEL 1,6500000,CDM,510,RC,99201,HCPCS,outpatient,,,68,34,,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.11,38.4,,20.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.8,35,,19.04,percent of total billed charges,35% of total billed charges for outpatient setting,53.04,78,,42.432,percent of total billed charges,78% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,47.6,70,,38.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51,75,,40.8,percent of total billed charges,75% of total billed charges for outpatient setting,56.44,83,,45.152,percent of total billed charges,83% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,34,50,,27.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.63,39.17,,21.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.8,56.44,
NEW OUTPATIENT LEVEL 2,6500001,CDM,510,RC,99202,HCPCS,outpatient,,,128,64,,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.15,38.4,,39.32,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.8,35,,35.84,percent of total billed charges,35% of total billed charges for outpatient setting,99.84,78,,79.872,percent of total billed charges,78% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,89.6,70,,71.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,75,,76.8,percent of total billed charges,75% of total billed charges for outpatient setting,106.24,83,,84.992,percent of total billed charges,83% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,64,50,,51.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.13,39.17,,40.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,44.8,106.24,
NEW OUTPATIENT LEVEL 3,6500002,CDM,510,RC,99203,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,97.5,50,,78,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,161.85,
NEW OUTPATIENT LEVEL 4,6500003,CDM,510,RC,99203,HCPCS,outpatient,,,206,103,,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,38.4,,63.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.1,35,,57.68,percent of total billed charges,35% of total billed charges for outpatient setting,160.68,78,,128.544,percent of total billed charges,78% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,144.2,70,,115.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,154.5,75,,123.6,percent of total billed charges,75% of total billed charges for outpatient setting,170.98,83,,136.784,percent of total billed charges,83% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,103,50,,82.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.68,39.17,,64.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.1,170.98,
NEW OUTPATIENT LEVEL 5,6500004,CDM,510,RC,99204,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ESTABLISHED OUTPATIENT LEVEL 1,6500006,CDM,510,RC,99211,HCPCS,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
ESTABLISHED OUTPATIENT LEVEL 2,6500007,CDM,510,RC,99212,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
ESTABLISHED OUTPATIENT LEVEL 3,6500008,CDM,510,RC,99213,HCPCS,outpatient,,,130,65,,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.92,38.4,,39.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.5,35,,36.4,percent of total billed charges,35% of total billed charges for outpatient setting,101.4,78,,81.12,percent of total billed charges,78% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,91,70,,72.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.5,75,,78,percent of total billed charges,75% of total billed charges for outpatient setting,107.9,83,,86.32,percent of total billed charges,83% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,65,50,,52,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.92,39.17,,40.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.5,107.9,
ESTABLISHED OUTPATIENT LEVEL 4,6500009,CDM,510,RC,99214,HCPCS,outpatient,,,199,99.5,,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.42,38.4,,61.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.65,35,,55.72,percent of total billed charges,35% of total billed charges for outpatient setting,155.22,78,,124.176,percent of total billed charges,78% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,139.3,70,,111.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.25,75,,119.4,percent of total billed charges,75% of total billed charges for outpatient setting,165.17,83,,132.136,percent of total billed charges,83% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,99.5,50,,79.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.95,39.17,,62.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,69.65,165.17,
ESTABLISHED OUTPATIENT LEVEL 5,6500010,CDM,510,RC,99215,HCPCS,outpatient,,,282,141,,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.29,38.4,,86.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.7,35,,78.96,percent of total billed charges,35% of total billed charges for outpatient setting,219.96,78,,175.968,percent of total billed charges,78% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,197.4,70,,157.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,211.5,75,,169.2,percent of total billed charges,75% of total billed charges for outpatient setting,234.06,83,,187.248,percent of total billed charges,83% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,141,50,,112.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.46,39.17,,88.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,98.7,234.06,
FOLLOW-UP CONSULT OUTPT LEVEL,6500011,CDM,510,RC,99241,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.05,68.89,
FOLLOW-UP CONSULT OUTPT LEVEL,6500012,CDM,510,RC,99242,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,60.55,143.59,
FOLLOW-UP CONSULT OUTPT LEVEL,6500013,CDM,510,RC,99243,HCPCS,outpatient,,,243,121.5,,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.05,35,,68.04,percent of total billed charges,35% of total billed charges for outpatient setting,189.54,78,,151.632,percent of total billed charges,78% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.69,83,,161.352,percent of total billed charges,83% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.18,39.17,,76.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.05,201.69,
FOLLOW-UP CONSULT OUTPT LEVEL,6500014,CDM,510,RC,99244,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
FOLLOW-UP CONSULT OUTPT LEVEL,6500015,CDM,510,RC,99245,HCPCS,outpatient,,,483,241.5,,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.05,35,,135.24,percent of total billed charges,35% of total billed charges for outpatient setting,376.74,78,,301.392,percent of total billed charges,78% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,400.89,83,,320.712,percent of total billed charges,83% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.18,39.17,,151.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,169.05,400.89,
INPATIENT ADMISSION LEVEL 1,6500016,CDM,510,RC,99221,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.3,35,,72.24,percent of total billed charges,35% of total billed charges for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,129,50,,103.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.05,39.17,,80.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,90.3,214.14,
INPATIENT ADMISSION LEVEL 2,6500017,CDM,510,RC,99222,HCPCS,outpatient,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,121.8,288.84,
INPATIENT ADMISSION LEVEL 3,6500018,CDM,510,RC,99223,HCPCS,outpatient,,,515,257.5,,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,197.76,38.4,,158.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180.25,35,,144.2,percent of total billed charges,35% of total billed charges for outpatient setting,401.7,78,,321.36,percent of total billed charges,78% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,360.5,70,,288.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,386.25,75,,309,percent of total billed charges,75% of total billed charges for outpatient setting,427.45,83,,341.96,percent of total billed charges,83% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,257.5,50,,206,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.72,39.17,,161.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,180.25,427.45,
SUBSEQUENT INPATIENT ADMISSION,6500019,CDM,510,RC,99231,HCPCS,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
SUBSEQUENT INPATIENT ADMISSION,6500020,CDM,510,RC,99232,HCPCS,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
SUBSEQUENT INPATIENT ADMISSION,6500021,CDM,510,RC,99233,HCPCS,outpatient,,,265,132.5,,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.76,38.4,,81.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,101.76,38.4,,81.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,198.75,75,,159,percent of total billed charges,75% of total billed charges for outpatient setting,198.75,75,,159,percent of total billed charges,75% of total billed charges for outpatient setting,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,198.75,75,,159,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.75,35,,74.2,percent of total billed charges,35% of total billed charges for outpatient setting,206.7,78,,165.36,percent of total billed charges,78% of total billed charges for outpatient setting,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,185.5,70,,148.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,198.75,75,,159,percent of total billed charges,75% of total billed charges for outpatient setting,219.95,83,,175.96,percent of total billed charges,83% of total billed charges for outpatient setting,132.5,50,,106,percent of total billed charges,50% of total billed charges for outpatient setting,132.5,50,,106,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.8,39.17,,83.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,92.75,219.95,
DISCHARGE INPATIENT LEVEL 1,6500022,CDM,510,RC,99238,HCPCS,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
DISCHARGE INPATIENT LEVEL 2,6500023,CDM,510,RC,99239,HCPCS,outpatient,,,271,135.5,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.85,35,,75.88,percent of total billed charges,35% of total billed charges for outpatient setting,211.38,78,,169.104,percent of total billed charges,78% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,224.93,83,,179.944,percent of total billed charges,83% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.14,39.17,,84.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,94.85,224.93,
INPATIENT CONSULT LEVEL 1,6500024,CDM,510,RC,99251,HCPCS,outpatient,,,125,62.5,,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.75,35,,35,percent of total billed charges,35% of total billed charges for outpatient setting,97.5,78,,78,percent of total billed charges,78% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,103.75,83,,83,percent of total billed charges,83% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.96,39.17,,39.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.75,103.75,
INPATIENT CONSULT LEVEL 2,6500025,CDM,510,RC,99252,HCPCS,outpatient,,,191,95.5,,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,73.34,38.4,,58.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.85,35,,53.48,percent of total billed charges,35% of total billed charges for outpatient setting,148.98,78,,119.184,percent of total billed charges,78% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,133.7,70,,106.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.25,75,,114.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.53,83,,126.824,percent of total billed charges,83% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,95.5,50,,76.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.81,39.17,,59.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.85,158.53,
INPATIENT CONSULT LEVEL 3,6500026,CDM,510,RC,99253,HCPCS,outpatient,,,292,146,,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.13,38.4,,89.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.13,38.4,,89.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.2,35,,81.76,percent of total billed charges,35% of total billed charges for outpatient setting,227.76,78,,182.208,percent of total billed charges,78% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,204.4,70,,163.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,219,75,,175.2,percent of total billed charges,75% of total billed charges for outpatient setting,242.36,83,,193.888,percent of total billed charges,83% of total billed charges for outpatient setting,146,50,,116.8,percent of total billed charges,50% of total billed charges for outpatient setting,146,50,,116.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.37,39.17,,91.496,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.2,242.36,
INPATIENT CONSULT LEVEL 4,6500027,CDM,510,RC,99254,HCPCS,outpatient,,,423,211.5,,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.43,38.4,,129.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.43,38.4,,129.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.05,35,,118.44,percent of total billed charges,35% of total billed charges for outpatient setting,329.94,78,,263.952,percent of total billed charges,78% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,296.1,70,,236.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,317.25,75,,253.8,percent of total billed charges,75% of total billed charges for outpatient setting,351.09,83,,280.872,percent of total billed charges,83% of total billed charges for outpatient setting,211.5,50,,169.2,percent of total billed charges,50% of total billed charges for outpatient setting,211.5,50,,169.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.68,39.17,,132.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.05,351.09,
INPATIENT CONSULT LEVEL 5,6500028,CDM,510,RC,99255,HCPCS,outpatient,,,511,255.5,,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,196.22,38.4,,156.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.85,35,,143.08,percent of total billed charges,35% of total billed charges for outpatient setting,398.58,78,,318.864,percent of total billed charges,78% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,357.7,70,,286.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,383.25,75,,306.6,percent of total billed charges,75% of total billed charges for outpatient setting,424.13,83,,339.304,percent of total billed charges,83% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,255.5,50,,204.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,200.14,39.17,,160.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,178.85,424.13,
CRITICAL CARE TIME PER HOUR,6500029,CDM,510,RC,99291,HCPCS,outpatient,,,571,285.5,,399.7,70,,319.76,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,219.26,38.4,,175.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,219.26,38.4,,175.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,571,70,,456.8,percent of total billed charges,70% of total billed charges for outpatient setting,571,70,,456.8,percent of total billed charges,70% of total billed charges for outpatient setting,571,70,,456.8,percent of total billed charges,70% of total billed charges for outpatient setting,571,75,,456.8,percent of total billed charges,75% of total billed charges for outpatient setting,571,75,,456.8,percent of total billed charges,75% of total billed charges for outpatient setting,399.7,70,,319.76,percent of total billed charges,70% of total billed charges for outpatient setting,571,75,,456.8,percent of total billed charges,75% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.85,35,,159.88,percent of total billed charges,35% of total billed charges for outpatient setting,445.38,78,,356.304,percent of total billed charges,78% of total billed charges for outpatient setting,399.7,70,,319.76,percent of total billed charges,70% of total billed charges for outpatient setting,399.7,70,,319.76,percent of total billed charges,70% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,428.25,75,,342.6,percent of total billed charges,75% of total billed charges for outpatient setting,473.93,83,,379.144,percent of total billed charges,83% of total billed charges for outpatient setting,285.5,50,,228.4,percent of total billed charges,50% of total billed charges for outpatient setting,285.5,50,,228.4,percent of total billed charges,50% of total billed charges for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,223.65,39.17,,178.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,762.23,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,199.85,762.23,
INITIAL OUTPATIENT CONSULT LEV,6500030,CDM,510,RC,99241,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,41.5,50,,33.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.05,68.89,
INITIAL OUTPATIENT CONSULT LEV,6500031,CDM,510,RC,99242,HCPCS,outpatient,,,173,86.5,,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.43,38.4,,53.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.55,35,,48.44,percent of total billed charges,35% of total billed charges for outpatient setting,134.94,78,,107.952,percent of total billed charges,78% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,121.1,70,,96.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.75,75,,103.8,percent of total billed charges,75% of total billed charges for outpatient setting,143.59,83,,114.872,percent of total billed charges,83% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,86.5,50,,69.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.76,39.17,,54.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,60.55,143.59,
INITIAL OUTPATIENT CONSULT LEV,6500032,CDM,510,RC,99243,HCPCS,outpatient,,,243,121.5,,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.31,38.4,,74.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.05,35,,68.04,percent of total billed charges,35% of total billed charges for outpatient setting,189.54,78,,151.632,percent of total billed charges,78% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,170.1,70,,136.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.25,75,,145.8,percent of total billed charges,75% of total billed charges for outpatient setting,201.69,83,,161.352,percent of total billed charges,83% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,121.5,50,,97.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.18,39.17,,76.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,85.05,201.69,
INITIAL OUTPATIENT CONSULT LEV,6500033,CDM,510,RC,99244,HCPCS,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
INITIAL OUTPATIENT CONSULT LEV,6500034,CDM,510,RC,99245,HCPCS,outpatient,,,483,241.5,,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.05,35,,135.24,percent of total billed charges,35% of total billed charges for outpatient setting,376.74,78,,301.392,percent of total billed charges,78% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,400.89,83,,320.712,percent of total billed charges,83% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.18,39.17,,151.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,169.05,400.89,
TRANSTHORACIC ECHO,6500035,CDM,480,RC,93307,HCPCS,outpatient,,,314,157,,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,120.58,38.4,,96.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,120.58,38.4,,96.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,189.51,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.9,35,,87.92,percent of total billed charges,35% of total billed charges for outpatient setting,244.92,78,,195.936,percent of total billed charges,78% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,260.62,83,,208.496,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,122.99,39.17,,98.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,210.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.9,424,
"STRESS TEST, TREADMILL, PHARMA",6500036,CDM,482,RC,93015,HCPCS,outpatient,,,258,129,,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.07,38.4,,79.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.3,35,,72.24,percent of total billed charges,35% of total billed charges for outpatient setting,201.24,78,,160.992,percent of total billed charges,78% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,180.6,70,,144.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.5,75,,154.8,percent of total billed charges,75% of total billed charges for outpatient setting,214.14,83,,171.312,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.05,39.17,,80.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,90.3,424,
BRONCHOSCOPY,6500037,CDM,980,RC,31624,HCPCS,outpatient,,,515,257.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"ENDOBRONCHIAL BIOPSY, FIRST TH",6500038,CDM,980,RC,,,outpatient,,,103,51.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"TRANSBRONCHIAL BIOPSY, FIRST T",6500039,CDM,980,RC,,,outpatient,,,103,51.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"BRUSHING, FIRST TWO",6500040,CDM,980,RC,,,outpatient,,,78,39,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
"BRONCHOALVEOLAR LAVAGE (BAL),",6500041,CDM,980,RC,31624,HCPCS,outpatient,,,352,176,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CENTRAL LINE,6500042,CDM,980,RC,,,outpatient,,,258,129,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
ARTERIAL LINE,6500043,CDM,980,RC,36640,HCPCS,outpatient,,,296,148,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
RIGHT HEART CATH,6500044,CDM,980,RC,93501,HCPCS,outpatient,,,515,257.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SWAN-GANZ CATHETER PLACEMENT,6500045,CDM,980,RC,93503,HCPCS,outpatient,,,336,168,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SWAN-GANZ CATHETER INTERPRETAT,6500046,CDM,980,RC,,,outpatient,,,52,26,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
VENTILATOR MANAGEMENT (PER DAY,6500047,CDM,980,RC,94002,HCPCS,outpatient,,,241,120.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
INTUBATION,6500048,CDM,980,RC,31500,HCPCS,outpatient,,,369,184.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PARACENTESIS/THORACENTESIS,6500049,CDM,980,RC,,,outpatient,,,206,103,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CHEST TUBE THORACOTOMY,6500050,CDM,980,RC,,,outpatient,,,412,206,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PERICARDIOCENTESIS,6500051,CDM,980,RC,,,outpatient,,,258,129,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PACEMAKER PLACEMENT (TEMPORARY,6500052,CDM,980,RC,,,outpatient,,,412,206,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
CARDIOVERSION,6500053,CDM,980,RC,92960,HCPCS,outpatient,,,309,154.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
PFT INTERPRETATION,6500054,CDM,460,RC,94016,HCPCS,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,22.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,22.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.96,424,
24 HOUR HOLTER INTERPRETATION,6500055,CDM,731,RC,93227,HCPCS,outpatient,,,155,77.5,,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.52,38.4,,47.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.25,35,,43.4,percent of total billed charges,35% of total billed charges for outpatient setting,120.9,78,,96.72,percent of total billed charges,78% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,108.5,70,,86.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,116.25,75,,93,percent of total billed charges,75% of total billed charges for outpatient setting,128.65,83,,102.92,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.71,39.17,,48.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,54.25,424,
EACH ADDITIONAL ENDOBRONCHIAL,6500056,CDM,360,RC,,,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.2,43.16,
EACH ADDITIONAL TRANSBRONCHIAL,6500057,CDM,360,RC,,,outpatient,,,78,39,,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.95,38.4,,23.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.3,35,,21.84,percent of total billed charges,35% of total billed charges for outpatient setting,60.84,78,,48.672,percent of total billed charges,78% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,54.6,70,,43.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.5,75,,46.8,percent of total billed charges,75% of total billed charges for outpatient setting,64.74,83,,51.792,percent of total billed charges,83% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,39,50,,31.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.55,39.17,,24.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,27.3,64.74,
EACH ADDITIONAL BRUSHING,6500058,CDM,360,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
EACH ADDITIONAL BAL,6500059,CDM,360,RC,31624,HCPCS,outpatient,,,352,176,,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,1457.91,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,135.17,38.4,,108.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.17,38.4,,108.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,264,75,,211.2,percent of total billed charges,75% of total billed charges for outpatient setting,264,75,,211.2,percent of total billed charges,75% of total billed charges for outpatient setting,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,264,75,,211.2,percent of total billed charges,75% of total billed charges for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.2,35,,98.56,percent of total billed charges,35% of total billed charges for outpatient setting,274.56,78,,219.648,percent of total billed charges,78% of total billed charges for outpatient setting,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,246.4,70,,197.12,percent of total billed charges,70% of total billed charges for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,264,75,,211.2,percent of total billed charges,75% of total billed charges for outpatient setting,292.16,83,,233.728,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,137.87,39.17,,110.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1457.91,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.2,2175,
EKG INTERPERTATION,6500061,CDM,980,RC,93010,HCPCS,outpatient,,,42,21,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
NURSING HOME VISIT,6500063,CDM,510,RC,99311,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
CRITICAL CARE ADDITIONAL 30 MI,6500064,CDM,510,RC,99292,HCPCS,outpatient,,,287,143.5,,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,110.21,38.4,,88.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.45,35,,80.36,percent of total billed charges,35% of total billed charges for outpatient setting,223.86,78,,179.088,percent of total billed charges,78% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,200.9,70,,160.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,215.25,75,,172.2,percent of total billed charges,75% of total billed charges for outpatient setting,238.21,83,,190.568,percent of total billed charges,83% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,143.5,50,,114.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.41,39.17,,89.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,100.45,238.21,
BRONCHOSCOPY W/ SUPERVISE CRNA,6500065,CDM,980,RC,31628,HCPCS,outpatient,,,458,229,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
JOINT INJECTION,6500066,CDM,980,RC,20610,HCPCS,outpatient,,,119,59.5,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SPINAL TAP,6500067,CDM,980,RC,62270,HCPCS,outpatient,,,224,112,,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,,,other,Not separately reimbursable for physician setting,,,
SIMPLE REPAIR,6500068,CDM,360,RC,12002,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.2,35,,42.56,percent of total billed charges,35% of total billed charges for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.54,39.17,,47.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.2,659,
E.R. LEVEL I PHYSICIAN VISIT,6500069,CDM,510,RC,99281,HCPCS,outpatient,,,137,68.5,,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.61,38.4,,42.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137,70,,109.6,percent of total billed charges,70% of total billed charges for outpatient setting,137,70,,109.6,percent of total billed charges,70% of total billed charges for outpatient setting,137,70,,109.6,percent of total billed charges,70% of total billed charges for outpatient setting,137,75,,109.6,percent of total billed charges,75% of total billed charges for outpatient setting,137,75,,109.6,percent of total billed charges,75% of total billed charges for outpatient setting,137,70,,109.6,percent of total billed charges,70% of total billed charges for outpatient setting,137,75,,109.6,percent of total billed charges,75% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.95,35,,38.36,percent of total billed charges,35% of total billed charges for outpatient setting,106.86,78,,85.488,percent of total billed charges,78% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,95.9,70,,76.72,percent of total billed charges,70% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,102.75,75,,82.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.71,83,,90.968,percent of total billed charges,83% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,68.5,50,,54.8,percent of total billed charges,50% of total billed charges for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.66,39.17,,42.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,76.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.95,137,
E.R. LEVEL II PHYSICIAN VISIT,6500070,CDM,510,RC,99282,HCPCS,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,140.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149,70,,119.2,percent of total billed charges,70% of total billed charges for outpatient setting,149,70,,119.2,percent of total billed charges,70% of total billed charges for outpatient setting,149,70,,119.2,percent of total billed charges,70% of total billed charges for outpatient setting,149,75,,119.2,percent of total billed charges,75% of total billed charges for outpatient setting,149,75,,119.2,percent of total billed charges,75% of total billed charges for outpatient setting,149,70,,119.2,percent of total billed charges,70% of total billed charges for outpatient setting,149,75,,119.2,percent of total billed charges,75% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,35,,41.72,percent of total billed charges,35% of total billed charges for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,74.5,50,,59.6,percent of total billed charges,50% of total billed charges for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.36,39.17,,46.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,140.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,149,
E.R. LEVEL III PHYSICIAN VISIT,6500071,CDM,510,RC,99283,HCPCS,outpatient,,,165,82.5,,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,245.08,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165,70,,132,percent of total billed charges,70% of total billed charges for outpatient setting,165,70,,132,percent of total billed charges,70% of total billed charges for outpatient setting,165,70,,132,percent of total billed charges,70% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,165,70,,132,percent of total billed charges,70% of total billed charges for outpatient setting,165,75,,132,percent of total billed charges,75% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,35,,46.2,percent of total billed charges,35% of total billed charges for outpatient setting,128.7,78,,102.96,percent of total billed charges,78% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,136.95,83,,109.56,percent of total billed charges,83% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.63,39.17,,51.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,245.08,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57.75,245.08,
E.R. LEVEL IV PHYSICIAN VISIT,6500072,CDM,510,RC,99284,HCPCS,outpatient,,,302,151,,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,115.97,38.4,,92.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.97,38.4,,92.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,302,70,,241.6,percent of total billed charges,70% of total billed charges for outpatient setting,302,70,,241.6,percent of total billed charges,70% of total billed charges for outpatient setting,302,70,,241.6,percent of total billed charges,70% of total billed charges for outpatient setting,302,75,,241.6,percent of total billed charges,75% of total billed charges for outpatient setting,302,75,,241.6,percent of total billed charges,75% of total billed charges for outpatient setting,302,70,,241.6,percent of total billed charges,70% of total billed charges for outpatient setting,302,75,,241.6,percent of total billed charges,75% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.7,35,,84.56,percent of total billed charges,35% of total billed charges for outpatient setting,235.56,78,,188.448,percent of total billed charges,78% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,211.4,70,,169.12,percent of total billed charges,70% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.5,75,,181.2,percent of total billed charges,75% of total billed charges for outpatient setting,250.66,83,,200.528,percent of total billed charges,83% of total billed charges for outpatient setting,151,50,,120.8,percent of total billed charges,50% of total billed charges for outpatient setting,151,50,,120.8,percent of total billed charges,50% of total billed charges for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.29,39.17,,94.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,380.44,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.7,380.44,
E.R. LEVEL V PHYSICIAN VISIT,6500073,CDM,510,RC,99285,HCPCS,outpatient,,,446,223,,312.2,70,,249.76,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,171.26,38.4,,137.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,171.26,38.4,,137.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,446,70,,356.8,percent of total billed charges,70% of total billed charges for outpatient setting,446,70,,356.8,percent of total billed charges,70% of total billed charges for outpatient setting,446,70,,356.8,percent of total billed charges,70% of total billed charges for outpatient setting,446,75,,356.8,percent of total billed charges,75% of total billed charges for outpatient setting,446,75,,356.8,percent of total billed charges,75% of total billed charges for outpatient setting,446,70,,356.8,percent of total billed charges,70% of total billed charges for outpatient setting,446,75,,356.8,percent of total billed charges,75% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.1,35,,124.88,percent of total billed charges,35% of total billed charges for outpatient setting,347.88,78,,278.304,percent of total billed charges,78% of total billed charges for outpatient setting,312.2,70,,249.76,percent of total billed charges,70% of total billed charges for outpatient setting,312.2,70,,249.76,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,334.5,75,,267.6,percent of total billed charges,75% of total billed charges for outpatient setting,370.18,83,,296.144,percent of total billed charges,83% of total billed charges for outpatient setting,223,50,,178.4,percent of total billed charges,50% of total billed charges for outpatient setting,223,50,,178.4,percent of total billed charges,50% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,174.69,39.17,,139.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,156.1,551.73,
ECHO DOPPLER PW/CW,6500074,CDM,480,RC,93320,HCPCS,outpatient,,,131,65.5,,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.3,38.4,,40.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,69.98,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.85,35,,36.68,percent of total billed charges,35% of total billed charges for outpatient setting,102.18,78,,81.744,percent of total billed charges,78% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,91.7,70,,73.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,98.25,75,,78.6,percent of total billed charges,75% of total billed charges for outpatient setting,108.73,83,,86.984,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,51.31,39.17,,41.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.85,424,
ECHO DOPPLER COLOR,6500075,CDM,480,RC,93325,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,43.91,100,,,fee schedule,100% Anthem fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,424,
OBSERVATION PATIENT LEVEL 1,6500076,CDM,510,RC,99218,HCPCS,outpatient,,,254,127,,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.54,38.4,,78.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,97.54,38.4,,78.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.9,35,,71.12,percent of total billed charges,35% of total billed charges for outpatient setting,198.12,78,,158.496,percent of total billed charges,78% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,177.8,70,,142.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.5,75,,152.4,percent of total billed charges,75% of total billed charges for outpatient setting,210.82,83,,168.656,percent of total billed charges,83% of total billed charges for outpatient setting,127,50,,101.6,percent of total billed charges,50% of total billed charges for outpatient setting,127,50,,101.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,99.49,39.17,,79.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,88.9,210.82,
OBSERVATION PATIENT LEVEL 2,6500077,CDM,510,RC,99219,HCPCS,outpatient,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,286.35,
OBSERVATION PATIENT LEVEL 3,6500078,CDM,510,RC,99220,HCPCS,outpatient,,,472,236,,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.25,38.4,,145,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.2,35,,132.16,percent of total billed charges,35% of total billed charges for outpatient setting,368.16,78,,294.528,percent of total billed charges,78% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,330.4,70,,264.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,354,75,,283.2,percent of total billed charges,75% of total billed charges for outpatient setting,391.76,83,,313.408,percent of total billed charges,83% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,236,50,,188.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.88,39.17,,147.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,165.2,391.76,
OBSERVATION DISCHARGE,6500079,CDM,510,RC,99217,HCPCS,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,92,50,,73.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.4,152.72,
SWINGBED HOSPITAL VISIT,6500080,CDM,510,RC,99311,HCPCS,outpatient,,,42,21,,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.13,38.4,,12.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.7,35,,11.76,percent of total billed charges,35% of total billed charges for outpatient setting,32.76,78,,26.208,percent of total billed charges,78% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,29.4,70,,23.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,75,,25.2,percent of total billed charges,75% of total billed charges for outpatient setting,34.86,83,,27.888,percent of total billed charges,83% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,21,50,,16.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.17,,13.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.7,34.86,
SWINGBED DISCHARGE,6500081,CDM,510,RC,99315,HCPCS,outpatient,,,185,92.5,,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.04,38.4,,56.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.75,35,,51.8,percent of total billed charges,35% of total billed charges for outpatient setting,144.3,78,,115.44,percent of total billed charges,78% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,129.5,70,,103.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.75,75,,111,percent of total billed charges,75% of total billed charges for outpatient setting,153.55,83,,122.84,percent of total billed charges,83% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,92.5,50,,74,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.46,39.17,,57.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.75,153.55,
OT HOME ASSESSMENT PER 15 MIN,8300030,CDM,431,RC,97535,HCPCS,outpatient,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,424,
OT E-STIM,8300035,CDM,431,RC,97014,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.25,35,,32.2,percent of total billed charges,35% of total billed charges for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.04,39.17,,36.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.25,424,
OT VASOPNEUMATIC PUMP,8300036,CDM,431,RC,97016,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,10.88,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.88,424,
OT PARAFFIN BATH,8300038,CDM,431,RC,97018,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,5.22,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.22,424,
OT TENS TREATMENT,8300039,CDM,431,RC,97014,HCPCS,outpatient,,,115,57.5,,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.16,38.4,,35.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.25,35,,32.2,percent of total billed charges,35% of total billed charges for outpatient setting,89.7,78,,71.76,percent of total billed charges,78% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,80.5,70,,64.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.25,75,,69,percent of total billed charges,75% of total billed charges for outpatient setting,95.45,83,,76.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.04,39.17,,36.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.25,424,
OT ULTRASOUND,8300040,CDM,431,RC,97035,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
OT CONTRAST BATH PER 15 MIN,8300041,CDM,431,RC,97034,HCPCS,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
OT TRACTION MECHANICAL,8300042,CDM,431,RC,97012,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.18,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.18,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.18,424,
OT DEVELOPMENTAL STIM PER 15 MIN,8300050,CDM,431,RC,97533,HCPCS,outpatient,,,141,70.5,,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,54.14,38.4,,43.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.14,38.4,,43.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,105.75,75,,84.6,percent of total billed charges,75% of total billed charges for outpatient setting,105.75,75,,84.6,percent of total billed charges,75% of total billed charges for outpatient setting,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,105.75,75,,84.6,percent of total billed charges,75% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,35,,39.48,percent of total billed charges,35% of total billed charges for outpatient setting,109.98,78,,87.984,percent of total billed charges,78% of total billed charges for outpatient setting,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,98.7,70,,78.96,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.75,75,,84.6,percent of total billed charges,75% of total billed charges for outpatient setting,117.03,83,,93.624,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.22,39.17,,44.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.35,424,
OT WHIRLPOOL,8300062,CDM,431,RC,97022,HCPCS,outpatient,,,113,56.5,,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,39.55,35,,31.64,percent of total billed charges,35% of total billed charges for outpatient setting,88.14,78,,70.512,percent of total billed charges,78% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.79,83,,75.032,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.26,39.17,,35.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,15.47,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.47,424,
OT MANUAL THERAPY PER 15 MIN,8300064,CDM,431,RC,97140,HCPCS,outpatient,,,171.33,85.67,,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,65.79,38.4,,52.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.79,38.4,,52.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,128.5,75,,102.8,percent of total billed charges,75% of total billed charges for outpatient setting,128.5,75,,102.8,percent of total billed charges,75% of total billed charges for outpatient setting,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,128.5,75,,102.8,percent of total billed charges,75% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.97,35,,47.976,percent of total billed charges,35% of total billed charges for outpatient setting,133.64,78,,106.912,percent of total billed charges,78% of total billed charges for outpatient setting,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,119.93,70,,95.944,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.5,75,,102.8,percent of total billed charges,75% of total billed charges for outpatient setting,142.2,83,,113.76,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,67.11,39.17,,53.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,424,
OT NEURO MUSCULAR RE-ED,8300067,CDM,431,RC,97112,HCPCS,outpatient,,,189.9,94.95,,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,72.92,38.4,,58.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.92,38.4,,58.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,142.43,75,,113.944,percent of total billed charges,75% of total billed charges for outpatient setting,142.43,75,,113.944,percent of total billed charges,75% of total billed charges for outpatient setting,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,142.43,75,,113.944,percent of total billed charges,75% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.47,35,,53.176,percent of total billed charges,35% of total billed charges for outpatient setting,148.12,78,,118.496,percent of total billed charges,78% of total billed charges for outpatient setting,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,132.93,70,,106.344,percent of total billed charges,70% of total billed charges for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,142.43,75,,113.944,percent of total billed charges,75% of total billed charges for outpatient setting,157.62,83,,126.096,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.38,39.17,,59.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.19,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.19,424,
OT THERAPEUTIC EXERCISE PER 15 MI,8300068,CDM,431,RC,97110,HCPCS,outpatient,,,181.46,90.73,,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,69.68,38.4,,55.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.68,38.4,,55.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.51,35,,50.808,percent of total billed charges,35% of total billed charges for outpatient setting,141.54,78,,113.232,percent of total billed charges,78% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,127.02,70,,101.616,percent of total billed charges,70% of total billed charges for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,136.1,75,,108.88,percent of total billed charges,75% of total billed charges for outpatient setting,150.61,83,,120.488,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.07,39.17,,56.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.24,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.24,424,
OT THERAPEUTIC ACTIVIT PER 15 MIN,8300069,CDM,431,RC,97530,HCPCS,outpatient,,,142.64,71.32,,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,54.77,38.4,,43.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,54.77,38.4,,43.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,49.92,35,,39.936,percent of total billed charges,35% of total billed charges for outpatient setting,111.26,78,,89.008,percent of total billed charges,78% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,99.85,70,,79.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106.98,75,,85.584,percent of total billed charges,75% of total billed charges for outpatient setting,118.39,83,,94.712,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.87,39.17,,44.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,33.56,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.56,424,
OT ADL HOME MGMT PER 15 MIN,8300073,CDM,431,RC,97535,HCPCS,outpatient,,,73.43,36.72,,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.2,38.4,,22.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.2,38.4,,22.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,55.07,75,,44.056,percent of total billed charges,75% of total billed charges for outpatient setting,55.07,75,,44.056,percent of total billed charges,75% of total billed charges for outpatient setting,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,55.07,75,,44.056,percent of total billed charges,75% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.7,35,,20.56,percent of total billed charges,35% of total billed charges for outpatient setting,57.28,78,,45.824,percent of total billed charges,78% of total billed charges for outpatient setting,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,51.4,70,,41.12,percent of total billed charges,70% of total billed charges for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.07,75,,44.056,percent of total billed charges,75% of total billed charges for outpatient setting,60.95,83,,48.76,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.76,39.17,,23.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,30.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.7,424,
OT WHEELCHAIR MANAGEMENT PER 15 M,8300074,CDM,431,RC,97542,HCPCS,outpatient,,,107.8,53.9,,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,41.4,38.4,,33.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.4,38.4,,33.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,80.85,75,,64.68,percent of total billed charges,75% of total billed charges for outpatient setting,80.85,75,,64.68,percent of total billed charges,75% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,80.85,75,,64.68,percent of total billed charges,75% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.73,35,,30.184,percent of total billed charges,35% of total billed charges for outpatient setting,84.08,78,,67.264,percent of total billed charges,78% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,75.46,70,,60.368,percent of total billed charges,70% of total billed charges for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,75,,64.68,percent of total billed charges,75% of total billed charges for outpatient setting,89.47,83,,71.576,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.23,39.17,,33.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,29.38,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.38,424,
OT GARMENT MEASURE PER 15 MIN,8300075,CDM,431,RC,97750,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,424,
OT TENS INITIAL,8300078,CDM,431,RC,64550,HCPCS,outpatient,,,63,31.5,,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.19,38.4,,19.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.05,35,,17.64,percent of total billed charges,35% of total billed charges for outpatient setting,49.14,78,,39.312,percent of total billed charges,78% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,44.1,70,,35.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.25,75,,37.8,percent of total billed charges,75% of total billed charges for outpatient setting,52.29,83,,41.832,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.67,39.17,,19.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.05,424,
OT TENS RECHEC FOLLOWUP,8300079,CDM,431,RC,97014,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,424,
OT DEBRIDEMENT SELECTIVE,8300080,CDM,431,RC,97597,HCPCS,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42,424,
OT DRESS,8300081,CDM,510,RC,99211,HCPCS,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
OT DEVELOPMENT COGNITIVE SKILLS P,8300087,CDM,431,RC,97532,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,424,
OT DEBRIDEMENT NONSELECTIVE,8300088,CDM,431,RC,97602,HCPCS,outpatient,,,259,129.5,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.65,35,,72.52,percent of total billed charges,35% of total billed charges for outpatient setting,202.02,78,,161.616,percent of total billed charges,78% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,214.97,83,,171.976,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.45,39.17,,81.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.65,424,
OT SPLINT LONG ARM,8300089,CDM,431,RC,29105,HCPCS,outpatient,,,152,76,,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.37,38.4,,46.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.2,35,,42.56,percent of total billed charges,35% of total billed charges for outpatient setting,118.56,78,,94.848,percent of total billed charges,78% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,106.4,70,,85.12,percent of total billed charges,70% of total billed charges for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114,75,,91.2,percent of total billed charges,75% of total billed charges for outpatient setting,126.16,83,,100.928,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,59.54,39.17,,47.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,135.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,53.2,424,
OT SPLINT SHORT ARM STATIC,8300090,CDM,431,RC,29125,HCPCS,outpatient,,,99,49.5,,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.02,38.4,,30.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.65,35,,27.72,percent of total billed charges,35% of total billed charges for outpatient setting,77.22,78,,61.776,percent of total billed charges,78% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,69.3,70,,55.44,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,74.25,75,,59.4,percent of total billed charges,75% of total billed charges for outpatient setting,82.17,83,,65.736,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.78,39.17,,31.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.65,424,
OT SPLINT SHORT ARM DYAMIC,8300091,CDM,431,RC,29126,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,35,,34.16,percent of total billed charges,35% of total billed charges for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.79,39.17,,38.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,424,
OT SPLINT FINGER STATIC,8300092,CDM,431,RC,29130,HCPCS,outpatient,,,256,128,,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.3,38.4,,78.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.3,38.4,,78.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.6,35,,71.68,percent of total billed charges,35% of total billed charges for outpatient setting,199.68,78,,159.744,percent of total billed charges,78% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,212.48,83,,169.984,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.27,39.17,,80.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.6,424,
OT SPLINT FINGER DYNAMIC,8300093,CDM,431,RC,29131,HCPCS,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.75,424,
OT MANUAL EXTREMITY OR TRUNK,8300094,CDM,431,RC,95831,HCPCS,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,424,
OT MANUAL HAND,8300095,CDM,431,RC,95832,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,424,
OT MANUAL TOTAL BODY W HANDS,8300096,CDM,431,RC,95834,HCPCS,outpatient,,,81,40.5,,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.1,38.4,,24.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.35,35,,22.68,percent of total billed charges,35% of total billed charges for outpatient setting,63.18,78,,50.544,percent of total billed charges,78% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,56.7,70,,45.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.75,75,,48.6,percent of total billed charges,75% of total billed charges for outpatient setting,67.23,83,,53.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.72,39.17,,25.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28.35,424,
OT ROM EA EXTREMITY TRUNK WO HAN,8300097,CDM,431,RC,95851,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,7.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,7.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7.34,424,
OT ROM HAND,8300098,CDM,431,RC,95852,HCPCS,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,5.12,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,5.12,424,
OT BIOFEEDBACK,8300099,CDM,431,RC,90901,HCPCS,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,18.2,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.5,424,
OT ORTHO FIT TRAIN PER 15 MIN,8300100,CDM,431,RC,97760,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,43.34,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.9,424,
OT PROSTHETIC FIT TRAIN PER 15 MI,8300101,CDM,431,RC,97761,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,38.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,38.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.05,424,
OT ORTHO PROSTHETIC CHECKOUT,8300102,CDM,431,RC,97762,HCPCS,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.6,424,
OT GENERAL EVALUATION PARTIAL,8300104,CDM,434,RC,97003,HCPCS,outpatient,,,195,97.5,,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.88,38.4,,59.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,35,,54.6,percent of total billed charges,35% of total billed charges for outpatient setting,152.1,78,,121.68,percent of total billed charges,78% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,136.5,70,,109.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.25,75,,117,percent of total billed charges,75% of total billed charges for outpatient setting,161.85,83,,129.48,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.38,39.17,,61.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.25,424,
OT GROUP THERAPY,8300105,CDM,431,RC,97150,HCPCS,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,16.8,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,15.4,424,
OT IONTOPHORESIS PER 15 MINUTE,8300106,CDM,431,RC,97033,HCPCS,outpatient,,,174,87,,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.84,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,66.82,38.4,,53.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.82,38.4,,53.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.9,35,,48.72,percent of total billed charges,35% of total billed charges for outpatient setting,135.72,78,,108.576,percent of total billed charges,78% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,121.8,70,,97.44,percent of total billed charges,70% of total billed charges for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,130.5,75,,104.4,percent of total billed charges,75% of total billed charges for outpatient setting,144.42,83,,115.536,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.16,39.17,,54.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,17.84,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,17.84,424,
OT COMBO US ESTIM,8300107,CDM,431,RC,97032,HCPCS,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.46,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.46,424,
OT PHONOPHORESIS,8300108,CDM,431,RC,97035,HCPCS,outpatient,,,83,41.5,,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.87,38.4,,25.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.05,35,,23.24,percent of total billed charges,35% of total billed charges for outpatient setting,64.74,78,,51.792,percent of total billed charges,78% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,58.1,70,,46.48,percent of total billed charges,70% of total billed charges for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,62.25,75,,49.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.89,83,,55.112,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.51,39.17,,26.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,13.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.02,424,
OT MOBILITY CURRENT STATUS,8300109,CDM,431,RC,G8978,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT MOBILITY GOAL STATUS,8300110,CDM,431,RC,G8979,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT MOBILITY DC STATUS,8300111,CDM,431,RC,G8980,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT BODY POSITION CURRENT STATUS,8300112,CDM,431,RC,G8981,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT BODY POSITION GOAL STATUS,8300113,CDM,431,RC,G8982,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT BODY POSITION D C STATUS,8300114,CDM,431,RC,G8983,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT CARRY CURRENT STATUS,8300115,CDM,431,RC,G8984,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT CARRY GOAL STATUS,8300116,CDM,431,RC,G8985,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT CARRY DC STATUS,8300117,CDM,431,RC,G8986,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SELF CARE CURRENT STATUS,8300118,CDM,431,RC,G8987,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SELF CARE GOAL STATUS,8300119,CDM,431,RC,G8988,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SELF-CARE GOAL STATUS,8300120,CDM,431,RC,G8989,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT OTHER PT OT CURRENT STATUS,8300121,CDM,431,RC,G8990,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT OTHER PT OT GOAL STATUS,8300122,CDM,431,RC,G8991,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT OTHER PT OT DC STATUS,8300123,CDM,431,RC,G8992,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SUB PT OT CURRENT STATUS,8300124,CDM,431,RC,G8993,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SUB PT OT GOAL STATUS,8300125,CDM,431,RC,G8984,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT SUB PT OT DC STATUS,8300126,CDM,431,RC,G8995,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT EVAL LOW COMPLEX 30 MIN,8300127,CDM,431,RC,97165GO,HCPCS,outpatient,,,489,244.5,,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.78,38.4,,150.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.78,38.4,,150.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,171.15,35,,136.92,percent of total billed charges,35% of total billed charges for outpatient setting,381.42,78,,305.136,percent of total billed charges,78% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,342.3,70,,273.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,366.75,75,,293.4,percent of total billed charges,75% of total billed charges for outpatient setting,405.87,83,,324.696,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,191.54,39.17,,153.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,171.15,424,
OT EVAL MOD COMPLEX 45 MIN,8300128,CDM,431,RC,97166,HCPCS,outpatient,,,412.72,206.36,,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.48,38.4,,126.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,144.45,35,,115.56,percent of total billed charges,35% of total billed charges for outpatient setting,321.92,78,,257.536,percent of total billed charges,78% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,288.9,70,,231.12,percent of total billed charges,70% of total billed charges for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.54,75,,247.632,percent of total billed charges,75% of total billed charges for outpatient setting,342.56,83,,274.048,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,161.65,39.17,,129.32,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,424,
OT EVAL HIGH COMPLEX 60 MIN,8300129,CDM,431,RC,97167,HCPCS,outpatient,,,684.6,342.3,,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,94.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,262.89,38.4,,210.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,262.89,38.4,,210.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,513.45,75,,410.76,percent of total billed charges,75% of total billed charges for outpatient setting,513.45,75,,410.76,percent of total billed charges,75% of total billed charges for outpatient setting,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,513.45,75,,410.76,percent of total billed charges,75% of total billed charges for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.61,35,,191.688,percent of total billed charges,35% of total billed charges for outpatient setting,533.99,78,,427.192,percent of total billed charges,78% of total billed charges for outpatient setting,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,479.22,70,,383.376,percent of total billed charges,70% of total billed charges for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,513.45,75,,410.76,percent of total billed charges,75% of total billed charges for outpatient setting,568.22,83,,454.576,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,268.15,39.17,,214.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,94.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,94.11,568.22,
OT RE-EVAL EST PLAN CARE,8300130,CDM,431,RC,97168,HCPCS,outpatient,,,256,128,,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,64.63,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,98.3,38.4,,78.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98.3,38.4,,78.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.6,35,,71.68,percent of total billed charges,35% of total billed charges for outpatient setting,199.68,78,,159.744,percent of total billed charges,78% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,179.2,70,,143.36,percent of total billed charges,70% of total billed charges for outpatient setting,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192,75,,153.6,percent of total billed charges,75% of total billed charges for outpatient setting,212.48,83,,169.984,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,100.27,39.17,,80.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,64.63,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.63,424,
OT OPTUM THERAPY SCREENING,8300131,CDM,431,RC,99368,HCPCS,outpatient,,,94,47,,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.1,38.4,,28.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.9,35,,26.32,percent of total billed charges,35% of total billed charges for outpatient setting,73.32,78,,58.656,percent of total billed charges,78% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,65.8,70,,52.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,75,,56.4,percent of total billed charges,75% of total billed charges for outpatient setting,78.02,83,,62.416,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.82,39.17,,29.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.9,424,
OT SELF CARE DC STATUS,8310120,CDM,431,RC,G8989,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT ORDER,8350000,CDM,430,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
OT-OTHER PT/OT CURRENT G8990-CH,8390000,CDM,430,RC,G8990CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CI,8390001,CDM,430,RC,G8990CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CJ,8390002,CDM,430,RC,G8990CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CK,8390003,CDM,430,RC,G8990CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CL,8390004,CDM,430,RC,G8990CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CM,8390005,CDM,430,RC,G8990CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT CURRENT G8990-CN,8390006,CDM,430,RC,G8990CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CH,8390007,CDM,430,RC,G9165CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CI,8390008,CDM,430,RC,G9165CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CJ,8390009,CDM,430,RC,G9165CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CK,8390010,CDM,430,RC,G9165CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CL,8390011,CDM,430,RC,G9165CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CM,8390012,CDM,430,RC,G9165CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN CURRENT G9165-CN,8390013,CDM,430,RC,G9165CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CH,8390014,CDM,430,RC,G9166CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CI,8390015,CDM,430,RC,G9166CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CJ,8390016,CDM,430,RC,G9166CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CK,8390017,CDM,430,RC,G9166CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CL,8390018,CDM,430,RC,G9166CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CM,8390019,CDM,430,RC,G9166CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN GOAL G9166-CN,8390020,CDM,430,RC,G9166CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CH,8390021,CDM,430,RC,G8981CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CI,8390022,CDM,430,RC,G8981CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CJ,8390023,CDM,430,RC,G8981CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CK,8390024,CDM,430,RC,G8981CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CL,8390025,CDM,430,RC,G8981CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CM,8390026,CDM,430,RC,G8981CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS CURRENT G8981-CN,8390027,CDM,430,RC,G8981CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CH,8390028,CDM,430,RC,G8986CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CI,8390029,CDM,430,RC,G8986CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CJ,8390030,CDM,430,RC,G8986CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CK,8390031,CDM,430,RC,G8986CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CL,8390032,CDM,430,RC,G8986CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CM,8390033,CDM,430,RC,G8986CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY DC G8986-CN,8390034,CDM,430,RC,G8986CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CH,8390035,CDM,430,RC,G8985CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CI,8390036,CDM,430,RC,G8985CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CJ,8390037,CDM,430,RC,G8985CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CK,8390038,CDM,430,RC,G8985CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CL,8390039,CDM,430,RC,G8985CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CM,8390040,CDM,430,RC,G8985CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY GOAL G8985-CN,8390041,CDM,430,RC,G8985CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CH,8390042,CDM,430,RC,G9168CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CI,8390043,CDM,430,RC,G9168CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CJ,8390044,CDM,430,RC,G9168CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CK,8390045,CDM,430,RC,G9168CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CL,8390046,CDM,430,RC,G9168CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CM,8390047,CDM,430,RC,G9168CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY CURRENT G9168-CN,8390048,CDM,430,RC,G9168CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CH,8390049,CDM,430,RC,G9170CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CI,8390050,CDM,430,RC,G9170CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CJ,8390051,CDM,430,RC,G9170CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CK,8390052,CDM,430,RC,G9170CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CL,8390053,CDM,430,RC,G9170CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CM,8390054,CDM,430,RC,G9170CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY DC G9170-CN,8390055,CDM,430,RC,G9170CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CH,8390056,CDM,430,RC,G9169CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CI,8390057,CDM,430,RC,G9169CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CJ,8390058,CDM,430,RC,G9169CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CK,8390059,CDM,430,RC,G9169CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CL,8390060,CDM,430,RC,G9169CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CM,8390061,CDM,430,RC,G9169CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MEMORY GOAL G9169-CN,8390062,CDM,430,RC,G9169CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CH,8390063,CDM,430,RC,G8989CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CI,8390064,CDM,430,RC,G8989CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CJ,8390065,CDM,430,RC,G8989CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CK,8390066,CDM,430,RC,G8989CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CL,8390067,CDM,430,RC,G8989CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CM,8390068,CDM,430,RC,G8989CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE DC G8989-CN,8390069,CDM,430,RC,G8989CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CH,8390070,CDM,430,RC,G8988CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CI,8390071,CDM,430,RC,G8988CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CJ,8390072,CDM,430,RC,G8988CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CK,8390073,CDM,430,RC,G8988CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CL,8390074,CDM,430,RC,G8988CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CM,8390075,CDM,430,RC,G8988CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE GOAL G8988-CN,8390076,CDM,430,RC,G8988CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CH,8390077,CDM,430,RC,G8994CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CI,8390078,CDM,430,RC,G8994CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CJ,8390079,CDM,430,RC,G8994CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CK,8390080,CDM,430,RC,G8994CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CL,8390081,CDM,430,RC,G8994CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CM,8390082,CDM,430,RC,G8994CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT GOAL G8994-CN,8390083,CDM,430,RC,G8994CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CH,8390084,CDM,430,RC,G9167CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CI,8390085,CDM,430,RC,G9167CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CJ,8390086,CDM,430,RC,G9167CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CK,8390087,CDM,430,RC,G9167CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CL,8390088,CDM,430,RC,G9167CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CM,8390089,CDM,430,RC,G9167CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-ATTEN DC G9167-CN,8390090,CDM,430,RC,G9167CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CH,8390091,CDM,430,RC,G8983CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CI,8390092,CDM,430,RC,G8983CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CJ,8390093,CDM,430,RC,G8983CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CK,8390094,CDM,430,RC,G8983CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CL,8390095,CDM,430,RC,G8983CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CM,8390096,CDM,430,RC,G8983CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS DC G8983-CN,8390097,CDM,430,RC,G8983CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CH,8390098,CDM,430,RC,G8982CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CI,8390099,CDM,430,RC,G8982CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CJ,8390100,CDM,430,RC,G8982CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CK,8390101,CDM,430,RC,G8982CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CL,8390102,CDM,430,RC,G8982CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CM,8390103,CDM,430,RC,G8982CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-BODY POS GOAL G8982-CN,8390104,CDM,430,RC,G8982CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CH,8390105,CDM,430,RC,G8984CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CI,8390106,CDM,430,RC,G8984CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CJ,8390107,CDM,430,RC,G8984CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CK,8390108,CDM,430,RC,G8984CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CL,8390109,CDM,430,RC,G8984CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CM,8390110,CDM,430,RC,G8984CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-CARRY CURRENT G8984 -CN,8390111,CDM,430,RC,G8984CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CH,8390112,CDM,430,RC,G8978CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CI,8390113,CDM,430,RC,G8978CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CJ,8390114,CDM,430,RC,G8978CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CK,8390115,CDM,430,RC,G8978CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CL,8390116,CDM,430,RC,G8978CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CM,8390117,CDM,430,RC,G8978CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY CURRENT G8978- CN,8390118,CDM,430,RC,G8978CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CH,8390119,CDM,430,RC,G8980CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CI,8390120,CDM,430,RC,G8980CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CJ,8390121,CDM,430,RC,G8980CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CK,8390122,CDM,430,RC,G8980CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CL,8390123,CDM,430,RC,G8980CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CM,8390124,CDM,430,RC,G8980CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY DC G8980-CN,8390125,CDM,430,RC,G8980CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CH,8390126,CDM,430,RC,G8979CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CI,8390127,CDM,430,RC,G8979CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CJ,8390128,CDM,430,RC,G8979CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CK,8390129,CDM,430,RC,G8979CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CL,8390130,CDM,430,RC,G8979CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CM,8390131,CDM,430,RC,G8979CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-MOBILITY GOAL G8979-CN,8390132,CDM,430,RC,G8979CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CH,8390133,CDM,430,RC,G8992CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CI,8390134,CDM,430,RC,G8992CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CJ,8390135,CDM,430,RC,G8992CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CK,8390136,CDM,430,RC,G8992CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CL,8390137,CDM,430,RC,G8992CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CM,8390138,CDM,430,RC,G8992CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT DC G8992-CN,8390139,CDM,430,RC,G8992CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CH,8390140,CDM,430,RC,G8991CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CI,8390141,CDM,430,RC,G8991CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CJ,8390142,CDM,430,RC,G8991CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CK,8390143,CDM,430,RC,G8991CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CL,8390144,CDM,430,RC,G8991CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CM,8390145,CDM,430,RC,G8991CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-OTHER PT/OT GOAL G8991-CN,8390146,CDM,430,RC,G8991CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CH,8390147,CDM,430,RC,G8987CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CI,8390148,CDM,430,RC,G8987CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CJ,8390149,CDM,430,RC,G8987CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CK,8390150,CDM,430,RC,G8987CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CL,8390151,CDM,430,RC,G8987CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CM,8390152,CDM,430,RC,G8987CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SELF-CARE CURRENT G8987-CN,8390153,CDM,430,RC,G8987CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CH,8390154,CDM,430,RC,G8993CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CI,8390155,CDM,430,RC,G8993CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CJ,8390156,CDM,430,RC,G8993CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CK,8390157,CDM,430,RC,G8993CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CL,8390158,CDM,430,RC,G8993CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CM,8390159,CDM,430,RC,G8993CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT CURRENT G8993-CN,8390160,CDM,430,RC,G8993CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CH,8390161,CDM,430,RC,G8995CHGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CI,8390162,CDM,430,RC,G8995CIGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CJ,8390163,CDM,430,RC,G8995CJGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CK,8390164,CDM,430,RC,G8995CKGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CL,8390165,CDM,430,RC,G8995CLGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CM,8390166,CDM,430,RC,G8995CMGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
OT-SUB PT/OT DC G8995-CN,8390167,CDM,430,RC,G8995CNGO,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST EVALUATION,8400071,CDM,440,RC,92506,HCPCS,outpatient,,,129,64.5,,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.54,38.4,,39.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.15,35,,36.12,percent of total billed charges,35% of total billed charges for outpatient setting,100.62,78,,80.496,percent of total billed charges,78% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,90.3,70,,72.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.75,75,,77.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.07,83,,85.656,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.53,39.17,,40.424,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,45.15,424,
SLP THERAPY,8400081,CDM,440,RC,92507,HCPCS,outpatient,,,167.11,83.56,,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,71.42,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.17,38.4,,51.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.17,38.4,,51.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,125.33,75,,100.264,percent of total billed charges,75% of total billed charges for outpatient setting,125.33,75,,100.264,percent of total billed charges,75% of total billed charges for outpatient setting,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,125.33,75,,100.264,percent of total billed charges,75% of total billed charges for outpatient setting,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.49,35,,46.792,percent of total billed charges,35% of total billed charges for outpatient setting,130.35,78,,104.28,percent of total billed charges,78% of total billed charges for outpatient setting,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,116.98,70,,93.584,percent of total billed charges,70% of total billed charges for outpatient setting,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.33,75,,100.264,percent of total billed charges,75% of total billed charges for outpatient setting,138.7,83,,110.96,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.45,39.17,,52.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,71.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.49,424,
ST ADD-ON EACH ADDITIONAL 15 MIN COGN FX,8400087,CDM,440,RC,97130,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,20.13,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,20.13,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.25,424,
ST EVAL FOR SWALLOWING/ORAL/PHARY,8400089,CDM,440,RC,92610,HCPCS,outpatient,,,259,129.5,,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,99.46,38.4,,79.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.65,35,,72.52,percent of total billed charges,35% of total billed charges for outpatient setting,202.02,78,,161.616,percent of total billed charges,78% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,181.3,70,,145.04,percent of total billed charges,70% of total billed charges for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,194.25,75,,155.4,percent of total billed charges,75% of total billed charges for outpatient setting,214.97,83,,171.976,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.45,39.17,,81.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,66.01,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66.01,424,
ST TREATMENT SWALLOWING/ORAL/FEED,8400090,CDM,440,RC,92526,HCPCS,outpatient,,,302.4,151.2,,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,78.81,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,116.12,38.4,,92.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.12,38.4,,92.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,226.8,75,,181.44,percent of total billed charges,75% of total billed charges for outpatient setting,226.8,75,,181.44,percent of total billed charges,75% of total billed charges for outpatient setting,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,226.8,75,,181.44,percent of total billed charges,75% of total billed charges for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,105.84,35,,84.672,percent of total billed charges,35% of total billed charges for outpatient setting,235.87,78,,188.696,percent of total billed charges,78% of total billed charges for outpatient setting,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,211.68,70,,169.344,percent of total billed charges,70% of total billed charges for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,226.8,75,,181.44,percent of total billed charges,75% of total billed charges for outpatient setting,250.99,83,,200.792,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,118.44,39.17,,94.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,78.81,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.81,424,
ST SPEECH THERAPY/GROUP,8400091,CDM,440,RC,92508,HCPCS,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,22.45,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,22.45,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.3,424,
ST MODIFIED BARIUM SWALLOW W/REPO,8400092,CDM,440,RC,92611,HCPCS,outpatient,,,218,109,,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,85.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,83.71,38.4,,66.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.3,35,,61.04,percent of total billed charges,35% of total billed charges for outpatient setting,170.04,78,,136.032,percent of total billed charges,78% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,152.6,70,,122.08,percent of total billed charges,70% of total billed charges for outpatient setting,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,163.5,75,,130.8,percent of total billed charges,75% of total billed charges for outpatient setting,180.94,83,,144.752,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,85.38,39.17,,68.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,85.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,76.3,424,
ST GENERAL EVALUATION/PARTIAL,8400093,CDM,444,RC,92506,HCPCS,outpatient,,,97,48.5,,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.25,38.4,,29.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.95,35,,27.16,percent of total billed charges,35% of total billed charges for outpatient setting,75.66,78,,60.528,percent of total billed charges,78% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,67.9,70,,54.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.75,75,,58.2,percent of total billed charges,75% of total billed charges for outpatient setting,80.51,83,,64.408,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38,39.17,,30.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.95,424,
ST DEVELOPMENTAL TESTING,8400094,CDM,440,RC,96110,HCPCS,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,424,
ST DEVELOPMENTAL TESTING EXTENDED,8400095,CDM,440,RC,96111,HCPCS,outpatient,,,319,159.5,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.65,35,,89.32,percent of total billed charges,35% of total billed charges for outpatient setting,248.82,78,,199.056,percent of total billed charges,78% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,264.77,83,,211.816,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.95,39.17,,99.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,111.65,424,
ST APHASIA ASSESSMENT,8400096,CDM,440,RC,96105,HCPCS,outpatient,,,456,228,,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,90.52,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.1,38.4,,140.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,159.6,35,,127.68,percent of total billed charges,35% of total billed charges for outpatient setting,355.68,78,,284.544,percent of total billed charges,78% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,319.2,70,,255.36,percent of total billed charges,70% of total billed charges for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342,75,,273.6,percent of total billed charges,75% of total billed charges for outpatient setting,378.48,83,,302.784,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,178.6,39.17,,142.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,424,
ST INITIAL 15 MIN COGN FX INTERVENTION,8400097,CDM,440,RC,97129,HCPCS,outpatient,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,21.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,21.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,19.25,424,
SENSORY INTEGRATION PRT 15 MIN,8400098,CDM,440,RC,97533,HCPCS,outpatient,,,74,37,,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.42,38.4,,22.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,35,,20.72,percent of total billed charges,35% of total billed charges for outpatient setting,57.72,78,,46.176,percent of total billed charges,78% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,51.8,70,,41.44,percent of total billed charges,70% of total billed charges for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.5,75,,44.4,percent of total billed charges,75% of total billed charges for outpatient setting,61.42,83,,49.136,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.99,39.17,,23.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,55.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.9,424,
ST THERAPEUTIC PER-USE OF SPEECH,8400099,CDM,440,RC,92609,HCPCS,outpatient,,,274,137,,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,95.69,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.9,35,,76.72,percent of total billed charges,35% of total billed charges for outpatient setting,213.72,78,,170.976,percent of total billed charges,78% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,227.42,83,,181.936,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,107.32,39.17,,85.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,95.69,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.69,424,
ST EVAL FOR SPEECH GEN DEV E/ADD,8400100,CDM,440,RC,92608,HCPCS,outpatient,,,132,66,,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,45.05,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.69,38.4,,40.552,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,35,,36.96,percent of total billed charges,35% of total billed charges for outpatient setting,102.96,78,,82.368,percent of total billed charges,78% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,92.4,70,,73.92,percent of total billed charges,70% of total billed charges for outpatient setting,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99,75,,79.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.56,83,,87.648,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,51.7,39.17,,41.36,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,45.05,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,45.05,424,
ST EVAL FOR SPEECH GEN DEV FIRST,8400101,CDM,440,RC,92607,HCPCS,outpatient,,,318,159,,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,115.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.11,38.4,,97.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.11,38.4,,97.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.3,35,,89.04,percent of total billed charges,35% of total billed charges for outpatient setting,248.04,78,,198.432,percent of total billed charges,78% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,222.6,70,,178.08,percent of total billed charges,70% of total billed charges for outpatient setting,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,238.5,75,,190.8,percent of total billed charges,75% of total billed charges for outpatient setting,263.94,83,,211.152,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.55,39.17,,99.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,115.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.3,424,
ST SWALLOW CURRENT STATUS,8400102,CDM,440,RC,G8996,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST SWALLOW GOAL STATUS,8400103,CDM,440,RC,G8997,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST SWALLOW D/C STATUS,8400104,CDM,440,RC,G8998,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MOTOR SPEECH CURRENT STATUS,8400105,CDM,440,RC,G8999,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MOTOR SPEECH GOAL STATUS,8400107,CDM,440,RC,G9186,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MOTOR SPEECH D/C STATUS,8400108,CDM,440,RC,G9158,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE COMP CURRENT STATUS,8400109,CDM,440,RC,G9159,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE COMP GOAL STATUS,8400110,CDM,440,RC,G9160,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE COMP D/C STATUS,8400111,CDM,440,RC,G9161,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE EXPRESS CURRENT STATU,8400112,CDM,440,RC,G9162,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE EXPRESS GOAL STATUS,8400113,CDM,440,RC,G9163,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST LANGUAGE EXPRESS D/C STATUS,8400114,CDM,440,RC,G9164,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST ATTENTION CURRENT STATUS,8400115,CDM,440,RC,G9165,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST ATTENTION GOAL STATUS,8400116,CDM,440,RC,G9166,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST ATTENTION D/C STATUS,8400117,CDM,440,RC,G9167,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MEMORY CURRENT STATUS,8400118,CDM,440,RC,G9168,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MEMORY GOAL STATUS,8400119,CDM,440,RC,G9169,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST MEMORY D/C STATUS,8400120,CDM,440,RC,G9170,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST VOICE CURRENT STATUS,8400121,CDM,440,RC,G9171,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST VOICE GOAL STATUS,8400122,CDM,440,RC,G9172,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST VOICE D/C STATUS,8400124,CDM,440,RC,G9173,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
SPEECH LANGUAGE CURRENT STATUS,8400125,CDM,440,RC,G9174,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
SPEECH LANGUAGE GOAL STATUS,8400126,CDM,440,RC,G9175,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
SPEECH LANGUAGE D/C STATUS,8400127,CDM,440,RC,G9176,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST EVALUATION OF SPEECH FLUENCY,8400128,CDM,440,RC,92521,HCPCS,outpatient,,,278,139,,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,124.42,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,106.75,38.4,,85.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,35,,77.84,percent of total billed charges,35% of total billed charges for outpatient setting,216.84,78,,173.472,percent of total billed charges,78% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,194.6,70,,155.68,percent of total billed charges,70% of total billed charges for outpatient setting,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,208.5,75,,166.8,percent of total billed charges,75% of total billed charges for outpatient setting,230.74,83,,184.592,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,108.89,39.17,,87.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,124.42,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,97.3,424,
ST EVAL SOUND PRODUCTION W/O LANG,8400129,CDM,440,RC,92522,HCPCS,outpatient,,,231,115.5,,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,104.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,35,,64.68,percent of total billed charges,35% of total billed charges for outpatient setting,180.18,78,,144.144,percent of total billed charges,78% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,191.73,83,,153.384,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.47,39.17,,72.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,424,
ST EVAL BEHAVIORAL/QUALITATIVE AN,8400130,CDM,440,RC,92524,HCPCS,outpatient,,,224,112,,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,103.03,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.02,38.4,,68.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.4,35,,62.72,percent of total billed charges,35% of total billed charges for outpatient setting,174.72,78,,139.776,percent of total billed charges,78% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,156.8,70,,125.44,percent of total billed charges,70% of total billed charges for outpatient setting,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,168,75,,134.4,percent of total billed charges,75% of total billed charges for outpatient setting,185.92,83,,148.736,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,87.74,39.17,,70.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,103.03,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,78.4,424,
ST EVALUATION SOUND PRODUCTION LA,8400131,CDM,440,RC,92523,HCPCS,outpatient,,,490,245,,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,35,,137.2,percent of total billed charges,35% of total billed charges for outpatient setting,382.2,78,,305.76,percent of total billed charges,78% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,406.7,83,,325.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.92,39.17,,153.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,424,
ST STANDARDIZED COGNITIVE PERFORM,8400132,CDM,440,RC,96125,HCPCS,outpatient,,,290,145,,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,95.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.5,35,,81.2,percent of total billed charges,35% of total billed charges for outpatient setting,226.2,78,,180.96,percent of total billed charges,78% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,240.7,83,,192.56,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.59,39.17,,90.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,424,
ST EVALUATION OF LANGUAGE ONLY,8400133,CDM,440,RC,92523,HCPCS,outpatient,,,490,245,,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,35,,137.2,percent of total billed charges,35% of total billed charges for outpatient setting,382.2,78,,305.76,percent of total billed charges,78% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,406.7,83,,325.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.92,39.17,,153.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,424,
ST STANDAR COGNITIVE PERF TEST<31,8400134,CDM,440,RC,96125,HCPCS,outpatient,,,290,145,,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,95.75,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,101.5,35,,81.2,percent of total billed charges,35% of total billed charges for outpatient setting,226.2,78,,180.96,percent of total billed charges,78% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,240.7,83,,192.56,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,113.59,39.17,,90.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,95.75,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,95.75,424,
ST APHASIA ASSESSMENT SHORTEN <31,8400135,CDM,440,RC,96105,HCPCS,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,90.52,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,90.52,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.52,424,
THER SERVICES COGNITIVE,8400136,CDM,440,RC,97127,HCPCS,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,424,
ST EVALUATION/SOUND PRODUCTION,8401219,CDM,440,RC,92522,HCPCS,outpatient,,,231,115.5,,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,104.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,88.7,38.4,,70.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,35,,64.68,percent of total billed charges,35% of total billed charges for outpatient setting,180.18,78,,144.144,percent of total billed charges,78% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,161.7,70,,129.36,percent of total billed charges,70% of total billed charges for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,173.25,75,,138.6,percent of total billed charges,75% of total billed charges for outpatient setting,191.73,83,,153.384,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,90.47,39.17,,72.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,104.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.85,424,
ST EVALUATION OF LANGUAGE,8450072,CDM,440,RC,92523,HCPCS,outpatient,,,490,245,,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,188.16,38.4,,150.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,35,,137.2,percent of total billed charges,35% of total billed charges for outpatient setting,382.2,78,,305.76,percent of total billed charges,78% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,343,70,,274.4,percent of total billed charges,70% of total billed charges for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,367.5,75,,294,percent of total billed charges,75% of total billed charges for outpatient setting,406.7,83,,325.36,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,191.92,39.17,,153.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,213.26,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.5,424,
ST ORDER,8459000,CDM,440,RC,,,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424,424,
ST-LANG COMP CURRENT G9159-CH,8490000,CDM,440,RC,G9159CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CI,8490001,CDM,440,RC,G9159CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CJ,8490002,CDM,440,RC,G9159CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CK,8490003,CDM,440,RC,G9159CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CL,8490004,CDM,440,RC,G9159CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CM,8490005,CDM,440,RC,G9159CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP CURRENT G9159-CN,8490006,CDM,440,RC,G9159CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CH,8490007,CDM,440,RC,G9161CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CI,8490008,CDM,440,RC,G9161CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CJ,8490009,CDM,440,RC,G9161CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CK,8490010,CDM,440,RC,G9161CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CL,8490011,CDM,440,RC,G9161CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CM,8490012,CDM,440,RC,G9161CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP DC G9161-CN,8490013,CDM,440,RC,G9161CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CH,8490014,CDM,440,RC,G9160CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CI,8490015,CDM,440,RC,G9160CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CJ,8490016,CDM,440,RC,G9160CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CK,8490017,CDM,440,RC,G9160CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CL,8490018,CDM,440,RC,G9160CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CM,8490019,CDM,440,RC,G9160CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG COMP GOAL G9160-CN,8490020,CDM,440,RC,G9160CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CH,8490021,CDM,440,RC,G9162CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CI,8490022,CDM,440,RC,G9162CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CJ,8490023,CDM,440,RC,G9162CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CK,8490024,CDM,440,RC,G9162CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CL,8490025,CDM,440,RC,G9162CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CM,8490026,CDM,440,RC,G9162CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS CURRENT G9162-CN,8490027,CDM,440,RC,G9162CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CH,8490028,CDM,440,RC,G9163CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CI,8490029,CDM,440,RC,G9163CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CJ,8490030,CDM,440,RC,G9163CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CK,8490031,CDM,440,RC,G9163CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CL,8490032,CDM,440,RC,G9163CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CM,8490033,CDM,440,RC,G9163CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS GOAL G9163-CN,8490034,CDM,440,RC,G9163CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CH,8490035,CDM,440,RC,G9186CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CI,8490036,CDM,440,RC,G9186CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CJ,8490037,CDM,440,RC,G9186CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CK,8490038,CDM,440,RC,G9186CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CL,8490039,CDM,440,RC,G9186CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CM,8490040,CDM,440,RC,G9186CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH GOAL G9186-CN,8490041,CDM,440,RC,G9186CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CH,8490042,CDM,440,RC,G9174CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CI,8490043,CDM,440,RC,G9174CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CJ,8490044,CDM,440,RC,G9174CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CK,8490045,CDM,440,RC,G9174CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CL,8490046,CDM,440,RC,G9174CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CM,8490047,CDM,440,RC,G9174CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG CURRENT G9174-CN,8490048,CDM,440,RC,G9174CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CH,8490049,CDM,440,RC,G9176CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CI,8490050,CDM,440,RC,G9176CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CJ,8490051,CDM,440,RC,G9176CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CK,8490052,CDM,440,RC,G9176CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CL,8490053,CDM,440,RC,G9176CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CM,8490054,CDM,440,RC,G9176CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG DC G9176-CN,8490055,CDM,440,RC,G9176CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CH,8490056,CDM,440,RC,G9175CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CI,8490057,CDM,440,RC,G9175CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CJ,8490058,CDM,440,RC,G9175CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CK,8490059,CDM,440,RC,G9175CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CL,8490060,CDM,440,RC,G9175CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CM,8490061,CDM,440,RC,G9175CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SPEECH LANG GOAL G9175-CN,8490062,CDM,440,RC,G9175CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CH,8490063,CDM,440,RC,G8997CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CI,8490064,CDM,440,RC,G8997CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CJ,8490065,CDM,440,RC,G8997CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CK,8490066,CDM,440,RC,G8997CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CL,8490067,CDM,440,RC,G8997CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CM,8490068,CDM,440,RC,G8997CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW GOAL G8997-CN,8490069,CDM,440,RC,G8997CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CH,8490070,CDM,440,RC,G9171CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CI,8490071,CDM,440,RC,G9171CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CJ,8490072,CDM,440,RC,G9171CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CK,8490073,CDM,440,RC,G9171CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CL,8490074,CDM,440,RC,G9171CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CM,8490075,CDM,440,RC,G9171CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE CURRENT G9171-CN,8490076,CDM,440,RC,G9171CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CH,8490077,CDM,440,RC,G9173CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CI,8490078,CDM,440,RC,G9173CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CJ,8490079,CDM,440,RC,G9173CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CK,8490080,CDM,440,RC,G9173CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CL,8490081,CDM,440,RC,G9173CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CM,8490082,CDM,440,RC,G9173CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE DC G9173-CN,8490083,CDM,440,RC,G9173CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CH,8490084,CDM,440,RC,G9164CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CI,8490085,CDM,440,RC,G9164CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CJ,8490086,CDM,440,RC,G9164CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CK,8490087,CDM,440,RC,G9164CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CL,8490088,CDM,440,RC,G9164CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CM,8490089,CDM,440,RC,G9164CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-LANG EXPRESS DC G9164 -CN,8490090,CDM,440,RC,G9164CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CH,8490091,CDM,440,RC,G8999CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CI,8490092,CDM,440,RC,G8999CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CJ,8490093,CDM,440,RC,G8999CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CK,8490094,CDM,440,RC,G8999CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CL,8490095,CDM,440,RC,G8999CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CM,8490096,CDM,440,RC,G8999CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH CURRENT G8999-CN,8490097,CDM,440,RC,G8999CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CH,8490098,CDM,440,RC,G9158CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CI,8490099,CDM,440,RC,G9158CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CJ,8490100,CDM,440,RC,G9158CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CK,8490101,CDM,440,RC,G9158CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CL,8490102,CDM,440,RC,G9158CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CM,8490103,CDM,440,RC,G9158CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-MOTOR SPEECH DC G9158-CN,8490104,CDM,440,RC,G9158CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CH,8490105,CDM,440,RC,G8996CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CI,8490106,CDM,440,RC,G8996CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CJ,8490107,CDM,440,RC,G8996CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CK,8490108,CDM,440,RC,G8996CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CL,8490109,CDM,440,RC,G8996CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CM,8490110,CDM,440,RC,G8996CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW CURRENT G8996-CN,8490111,CDM,440,RC,G8996CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CH,8490112,CDM,440,RC,G8998CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CI,8490113,CDM,440,RC,G8998CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CJ,8490114,CDM,440,RC,G8998CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CK,8490115,CDM,440,RC,G8998CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CL,8490116,CDM,440,RC,G8998CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CM,8490117,CDM,440,RC,G8998CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-SWALLOW DC G8998-CN,8490118,CDM,440,RC,G8998CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CH,8490119,CDM,440,RC,G9172CHGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CI,8490120,CDM,440,RC,G9172CIGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CJ,8490121,CDM,440,RC,G9172CJGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CK,8490122,CDM,440,RC,G9172CKGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CL,8490123,CDM,440,RC,G9172CLGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CM,8490124,CDM,440,RC,G9172CMGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
ST-VOICE GOAL G9172-CN,8490125,CDM,440,RC,G9172CNGN,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.35,424,
EVALUATION,8500000,CDM,421,RC,97750,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,31.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,28.7,424,
MASSAGE / PER 15MIN,8500001,CDM,421,RC,97124,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,27.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,27.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,22.75,424,
MANUAL THERAPY / PER 15MIN,8500011,CDM,421,RC,97140,HCPCS,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,25.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.14,424,
BRACE - HI-LO CYLINDER,9009408,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TIP - NATUS 4.5MM BLUE EAR INFANT,9009410,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
OBSERVATION,9400108,CDM,762,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,2,
OBSERVATION 4-8,9400109,CDM,762,RC,,,outpatient,,,232,116,,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89.09,38.4,,71.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,232,70,,185.6,percent of total billed charges,70% of total billed charges for outpatient setting,232,70,,185.6,percent of total billed charges,70% of total billed charges for outpatient setting,232,70,,185.6,percent of total billed charges,70% of total billed charges for outpatient setting,232,75,,185.6,percent of total billed charges,75% of total billed charges for outpatient setting,232,75,,185.6,percent of total billed charges,75% of total billed charges for outpatient setting,232,70,,185.6,percent of total billed charges,70% of total billed charges for outpatient setting,232,75,,185.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.2,35,,64.96,percent of total billed charges,35% of total billed charges for outpatient setting,180.96,78,,144.768,percent of total billed charges,78% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,162.4,70,,129.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174,75,,139.2,percent of total billed charges,75% of total billed charges for outpatient setting,192.56,83,,154.048,percent of total billed charges,83% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,116,50,,92.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.87,39.17,,72.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,81.2,232,
OBSER.,9411164,CDM,762,RC,99220,HCPCS,outpatient,,,458,229,,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175.87,38.4,,140.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,458,70,,366.4,percent of total billed charges,70% of total billed charges for outpatient setting,458,70,,366.4,percent of total billed charges,70% of total billed charges for outpatient setting,458,70,,366.4,percent of total billed charges,70% of total billed charges for outpatient setting,458,75,,366.4,percent of total billed charges,75% of total billed charges for outpatient setting,458,75,,366.4,percent of total billed charges,75% of total billed charges for outpatient setting,458,70,,366.4,percent of total billed charges,70% of total billed charges for outpatient setting,458,75,,366.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.3,35,,128.24,percent of total billed charges,35% of total billed charges for outpatient setting,357.24,78,,285.792,percent of total billed charges,78% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,320.6,70,,256.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,343.5,75,,274.8,percent of total billed charges,75% of total billed charges for outpatient setting,380.14,83,,304.112,percent of total billed charges,83% of total billed charges for outpatient setting,229,50,,183.2,percent of total billed charges,50% of total billed charges for outpatient setting,229,50,,183.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,179.39,39.17,,143.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,160.3,458,
OBSERVATION CCU 0-2,9411165,CDM,762,RC,,,outpatient,,,596,298,,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.86,38.4,,183.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.86,38.4,,183.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,596,70,,476.8,percent of total billed charges,70% of total billed charges for outpatient setting,596,70,,476.8,percent of total billed charges,70% of total billed charges for outpatient setting,596,70,,476.8,percent of total billed charges,70% of total billed charges for outpatient setting,596,75,,476.8,percent of total billed charges,75% of total billed charges for outpatient setting,596,75,,476.8,percent of total billed charges,75% of total billed charges for outpatient setting,596,70,,476.8,percent of total billed charges,70% of total billed charges for outpatient setting,596,75,,476.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,208.6,35,,166.88,percent of total billed charges,35% of total billed charges for outpatient setting,464.88,78,,371.904,percent of total billed charges,78% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,417.2,70,,333.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,447,75,,357.6,percent of total billed charges,75% of total billed charges for outpatient setting,494.68,83,,395.744,percent of total billed charges,83% of total billed charges for outpatient setting,298,50,,238.4,percent of total billed charges,50% of total billed charges for outpatient setting,298,50,,238.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,233.44,39.17,,186.752,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,208.6,596,
DEFINIT/OBS 0-2 HRS,9420470,CDM,762,RC,G0378,HCPCS,outpatient,,,392,196,,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.53,38.4,,120.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,75,,313.6,percent of total billed charges,75% of total billed charges for outpatient setting,392,75,,313.6,percent of total billed charges,75% of total billed charges for outpatient setting,392,70,,313.6,percent of total billed charges,70% of total billed charges for outpatient setting,392,75,,313.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.2,35,,109.76,percent of total billed charges,35% of total billed charges for outpatient setting,305.76,78,,244.608,percent of total billed charges,78% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,274.4,70,,219.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,294,75,,235.2,percent of total billed charges,75% of total billed charges for outpatient setting,325.36,83,,260.288,percent of total billed charges,83% of total billed charges for outpatient setting,196,50,,156.8,percent of total billed charges,50% of total billed charges for outpatient setting,196,50,,156.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153.54,39.17,,122.832,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,137.2,392,
DEFINIT/OBS,9420474,CDM,762,RC,G0378,HCPCS,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,2,
DEFINIT/OBS CHF/ASTHMA/CHEST P,9420475,CDM,762,RC,,,outpatient,,,2,1,,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.77,38.4,,0.616,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,2,70,,1.6,percent of total billed charges,70% of total billed charges for outpatient setting,2,75,,1.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.7,35,,0.56,percent of total billed charges,35% of total billed charges for outpatient setting,1.56,78,,1.248,percent of total billed charges,78% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,1.4,70,,1.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.5,75,,1.2,percent of total billed charges,75% of total billed charges for outpatient setting,1.66,83,,1.328,percent of total billed charges,83% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,1,50,,0.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.79,39.17,,0.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.7,2,
OBSERVATION HOURS AUTO OBS,9420476,CDM,762,RC,G0378,HCPCS,outpatient,,,8.35,4.18,,5.85,70,,4.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.21,38.4,,2.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.21,38.4,,2.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.35,70,,6.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.35,70,,6.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.35,70,,6.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.35,75,,6.68,percent of total billed charges,75% of total billed charges for outpatient setting,8.35,75,,6.68,percent of total billed charges,75% of total billed charges for outpatient setting,8.35,70,,6.68,percent of total billed charges,70% of total billed charges for outpatient setting,8.35,75,,6.68,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.92,35,,2.336,percent of total billed charges,35% of total billed charges for outpatient setting,6.51,78,,5.208,percent of total billed charges,78% of total billed charges for outpatient setting,5.85,70,,4.68,percent of total billed charges,70% of total billed charges for outpatient setting,5.85,70,,4.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,75,,5.008,percent of total billed charges,75% of total billed charges for outpatient setting,6.93,83,,5.544,percent of total billed charges,83% of total billed charges for outpatient setting,4.18,50,,3.344,percent of total billed charges,50% of total billed charges for outpatient setting,4.18,50,,3.344,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.27,39.17,,2.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.92,8.35,
DIRECT ADM OF OBSERVATION,9420477,CDM,762,RC,G0379,HCPCS,outpatient,,,1,0.5,,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.38,38.4,,0.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1,70,,0.8,percent of total billed charges,70% of total billed charges for outpatient setting,1,70,,0.8,percent of total billed charges,70% of total billed charges for outpatient setting,1,70,,0.8,percent of total billed charges,70% of total billed charges for outpatient setting,1,75,,0.8,percent of total billed charges,75% of total billed charges for outpatient setting,1,75,,0.8,percent of total billed charges,75% of total billed charges for outpatient setting,1,70,,0.8,percent of total billed charges,70% of total billed charges for outpatient setting,1,75,,0.8,percent of total billed charges,75% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.35,35,,0.28,percent of total billed charges,35% of total billed charges for outpatient setting,0.78,78,,0.624,percent of total billed charges,78% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,0.7,70,,0.56,percent of total billed charges,70% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.75,75,,0.6,percent of total billed charges,75% of total billed charges for outpatient setting,0.83,83,,0.664,percent of total billed charges,83% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,0.5,50,,0.4,percent of total billed charges,50% of total billed charges for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.39,39.17,,0.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,551.73,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,0.35,551.73,
TREATMENT ROOM 0-8,9421474,CDM,761,RC,99204,HCPCS,outpatient,,,320,160,,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112,35,,89.6,percent of total billed charges,35% of total billed charges for outpatient setting,249.6,78,,199.68,percent of total billed charges,78% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,265.6,83,,212.48,percent of total billed charges,83% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.34,39.17,,100.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,112,265.6,
TREATMENT ROOM 9-16,9421475,CDM,761,RC,99204,HCPCS,outpatient,,,320,160,,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112,35,,89.6,percent of total billed charges,35% of total billed charges for outpatient setting,249.6,78,,199.68,percent of total billed charges,78% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,265.6,83,,212.48,percent of total billed charges,83% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.34,39.17,,100.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,112,265.6,
TREATMENT ROOM 17-24,9421476,CDM,761,RC,99204,HCPCS,outpatient,,,320,160,,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112,35,,89.6,percent of total billed charges,35% of total billed charges for outpatient setting,249.6,78,,199.68,percent of total billed charges,78% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,265.6,83,,212.48,percent of total billed charges,83% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.34,39.17,,100.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,112,265.6,
TM TELEMEDICINE CONSULTATION,10000000,CDM,510,RC,Q3014,HCPCS,outpatient,,,70.05,35.03,,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.9,38.4,,21.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.9,38.4,,21.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,75,,42.032,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,75,,42.032,percent of total billed charges,75% of total billed charges for outpatient setting,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,75,,42.032,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.52,35,,19.616,percent of total billed charges,35% of total billed charges for outpatient setting,54.64,78,,43.712,percent of total billed charges,78% of total billed charges for outpatient setting,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,49.04,70,,39.232,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.54,75,,42.032,percent of total billed charges,75% of total billed charges for outpatient setting,58.14,83,,46.512,percent of total billed charges,83% of total billed charges for outpatient setting,35.03,50,,28.024,percent of total billed charges,50% of total billed charges for outpatient setting,35.03,50,,28.024,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.44,39.17,,21.952,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,24.52,58.14,
TELEMEDICINE CONSULTATION NEW,10000001,CDM,510,RC,99244,HCPCS,outpatient,,,379,189.5,,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.54,38.4,,116.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.54,38.4,,116.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.65,35,,106.12,percent of total billed charges,35% of total billed charges for outpatient setting,295.62,78,,236.496,percent of total billed charges,78% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,314.57,83,,251.656,percent of total billed charges,83% of total billed charges for outpatient setting,189.5,50,,151.6,percent of total billed charges,50% of total billed charges for outpatient setting,189.5,50,,151.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.45,39.17,,118.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,132.65,314.57,
TELEMEDICINE EST PAT 25 MIN,10000002,CDM,510,RC,99214,HCPCS,outpatient,,,193,96.5,,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.11,38.4,,59.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.11,38.4,,59.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.55,35,,54.04,percent of total billed charges,35% of total billed charges for outpatient setting,150.54,78,,120.432,percent of total billed charges,78% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,160.19,83,,128.152,percent of total billed charges,83% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.59,39.17,,60.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.55,160.19,
TELEMEDICINE EST PAT VIST 40 M,10000003,CDM,510,RC,99215,HCPCS,outpatient,,,274,137,,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.9,35,,76.72,percent of total billed charges,35% of total billed charges for outpatient setting,213.72,78,,170.976,percent of total billed charges,78% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,227.42,83,,181.936,percent of total billed charges,83% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.32,39.17,,85.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,95.9,227.42,
DIABETIC ED,10099906,CDM,942,RC,99404,HCPCS,outpatient,,,246,123,,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,94.46,38.4,,75.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.1,35,,68.88,percent of total billed charges,35% of total billed charges for outpatient setting,191.88,78,,153.504,percent of total billed charges,78% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,172.2,70,,137.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,184.5,75,,147.6,percent of total billed charges,75% of total billed charges for outpatient setting,204.18,83,,163.344,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96.35,39.17,,77.08,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,86.1,212,
CODE BLUE,11500000,CDM,480,RC,92950,HCPCS,outpatient,,,471,235.5,,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180.86,38.4,,144.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.85,35,,131.88,percent of total billed charges,35% of total billed charges for outpatient setting,367.38,78,,293.904,percent of total billed charges,78% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,329.7,70,,263.76,percent of total billed charges,70% of total billed charges for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,353.25,75,,282.6,percent of total billed charges,75% of total billed charges for outpatient setting,390.93,83,,312.744,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.48,39.17,,147.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,269.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,164.85,424,
CARDIOVERSION,11500001,CDM,480,RC,92960,HCPCS,outpatient,,,883,441.5,,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,339.07,38.4,,271.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.07,38.4,,271.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,662.25,75,,529.8,percent of total billed charges,75% of total billed charges for outpatient setting,662.25,75,,529.8,percent of total billed charges,75% of total billed charges for outpatient setting,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,662.25,75,,529.8,percent of total billed charges,75% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.05,35,,247.24,percent of total billed charges,35% of total billed charges for outpatient setting,688.74,78,,550.992,percent of total billed charges,78% of total billed charges for outpatient setting,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,618.1,70,,494.48,percent of total billed charges,70% of total billed charges for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,662.25,75,,529.8,percent of total billed charges,75% of total billed charges for outpatient setting,732.89,83,,586.312,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,345.85,39.17,,276.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,559.04,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,309.05,732.89,
RIGHT HEART CATH,11500005,CDM,480,RC,93501,HCPCS,outpatient,,,800,400,,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,307.2,38.4,,245.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,307.2,38.4,,245.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,600,75,,480,percent of total billed charges,75% of total billed charges for outpatient setting,600,75,,480,percent of total billed charges,75% of total billed charges for outpatient setting,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,600,75,,480,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,280,35,,224,percent of total billed charges,35% of total billed charges for outpatient setting,624,78,,499.2,percent of total billed charges,78% of total billed charges for outpatient setting,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,560,70,,448,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600,75,,480,percent of total billed charges,75% of total billed charges for outpatient setting,664,83,,531.2,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,313.34,39.17,,250.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,280,664,
DEBRIDEMENT SKIN/FULL THICKNES,11500006,CDM,360,RC,11041,HCPCS,outpatient,,,95,47.5,,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.25,35,,26.6,percent of total billed charges,35% of total billed charges for outpatient setting,74.1,78,,59.28,percent of total billed charges,78% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,78.85,83,,63.08,percent of total billed charges,83% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.21,39.17,,29.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.25,78.85,
DEBRIDEMENT OF NAILS - 6 OR MO,11500007,CDM,360,RC,11721,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,35,,34.16,percent of total billed charges,35% of total billed charges for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.79,39.17,,38.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,659,
TEMPORARY PACEMAKER,11500008,CDM,360,RC,33210,HCPCS,outpatient,,,9204,4602,,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,7297.61,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,3534.34,38.4,,2827.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3534.34,38.4,,2827.472,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,6903,75,,5522.4,percent of total billed charges,75% of total billed charges for outpatient setting,6903,75,,5522.4,percent of total billed charges,75% of total billed charges for outpatient setting,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,6903,75,,5522.4,percent of total billed charges,75% of total billed charges for outpatient setting,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3221.4,35,,2577.12,percent of total billed charges,35% of total billed charges for outpatient setting,7179.12,78,,5743.296,percent of total billed charges,78% of total billed charges for outpatient setting,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,6442.8,70,,5154.24,percent of total billed charges,70% of total billed charges for outpatient setting,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,6903,75,,5522.4,percent of total billed charges,75% of total billed charges for outpatient setting,7639.32,83,,6111.456,percent of total billed charges,83% of total billed charges for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,5560,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3605.03,39.17,,2884.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,7297.61,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3221.4,7639.32,
IV INFUSION IST HOUR,11500010,CDM,260,RC,96365,HCPCS,outpatient,,,956.2,478.1,,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,367.18,38.4,,293.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.18,38.4,,293.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,717.15,75,,573.72,percent of total billed charges,75% of total billed charges for outpatient setting,717.15,75,,573.72,percent of total billed charges,75% of total billed charges for outpatient setting,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,717.15,75,,573.72,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,334.67,35,,267.736,percent of total billed charges,35% of total billed charges for outpatient setting,745.84,78,,596.672,percent of total billed charges,78% of total billed charges for outpatient setting,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,669.34,70,,535.472,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,717.15,75,,573.72,percent of total billed charges,75% of total billed charges for outpatient setting,793.65,83,,634.92,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,374.52,39.17,,299.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,793.65,
IV INFUSION EACH ADD L HOUR,11500011,CDM,260,RC,96366,HCPCS,outpatient,,,61.6,30.8,,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,23.65,38.4,,18.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.65,38.4,,18.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.56,35,,17.248,percent of total billed charges,35% of total billed charges for outpatient setting,48.05,78,,38.44,percent of total billed charges,78% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,43.12,70,,34.496,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.2,75,,36.96,percent of total billed charges,75% of total billed charges for outpatient setting,51.13,83,,40.904,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,24.12,39.17,,19.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,21.56,212,
INJECTION IM ANTIOBIOTIC,11500012,CDM,761,RC,96372,HCPCS,outpatient,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.05,35,,34.44,percent of total billed charges,35% of total billed charges for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.17,39.17,,38.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.05,102.09,
INJECTION IM THERAPEUTIC,11500013,CDM,260,RC,96372,HCPCS,outpatient,,,180.62,90.31,,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,69.36,38.4,,55.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.36,38.4,,55.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,135.47,75,,108.376,percent of total billed charges,75% of total billed charges for outpatient setting,135.47,75,,108.376,percent of total billed charges,75% of total billed charges for outpatient setting,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,135.47,75,,108.376,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.22,35,,50.576,percent of total billed charges,35% of total billed charges for outpatient setting,140.88,78,,112.704,percent of total billed charges,78% of total billed charges for outpatient setting,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,126.43,70,,101.144,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,135.47,75,,108.376,percent of total billed charges,75% of total billed charges for outpatient setting,149.91,83,,119.928,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,70.75,39.17,,56.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,212,
INJECTION IM STEROID,11500014,CDM,761,RC,96372,HCPCS,outpatient,,,123,61.5,,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.23,38.4,,37.784,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.05,35,,34.44,percent of total billed charges,35% of total billed charges for outpatient setting,95.94,78,,76.752,percent of total billed charges,78% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,86.1,70,,68.88,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,92.25,75,,73.8,percent of total billed charges,75% of total billed charges for outpatient setting,102.09,83,,81.672,percent of total billed charges,83% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,61.5,50,,49.2,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,48.17,39.17,,38.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,43.05,102.09,
INJECTION IM TRANQUALIZER,11500015,CDM,761,RC,96372,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,73.04,
INJECTION IV ANTIBIOTIC,11500016,CDM,260,RC,96374,HCPCS,outpatient,,,149,74.5,,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.22,38.4,,45.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,35,,41.72,percent of total billed charges,35% of total billed charges for outpatient setting,116.22,78,,92.976,percent of total billed charges,78% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,104.3,70,,83.44,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.75,75,,89.4,percent of total billed charges,75% of total billed charges for outpatient setting,123.67,83,,98.936,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.36,39.17,,46.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.15,212,
INJECTION IV THERAPUTIC,11500017,CDM,761,RC,96374,HCPCS,outpatient,,,329.16,164.58,,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,126.4,38.4,,101.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.4,38.4,,101.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,246.87,75,,197.496,percent of total billed charges,75% of total billed charges for outpatient setting,246.87,75,,197.496,percent of total billed charges,75% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,246.87,75,,197.496,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.21,35,,92.168,percent of total billed charges,35% of total billed charges for outpatient setting,256.74,78,,205.392,percent of total billed charges,78% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,230.41,70,,184.328,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.87,75,,197.496,percent of total billed charges,75% of total billed charges for outpatient setting,273.2,83,,218.56,percent of total billed charges,83% of total billed charges for outpatient setting,164.58,50,,131.664,percent of total billed charges,50% of total billed charges for outpatient setting,164.58,50,,131.664,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,128.93,39.17,,103.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.21,273.2,
INJECTION IV TRANQUILIZER,11500018,CDM,761,RC,96374,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,35,,37.24,percent of total billed charges,35% of total billed charges for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,66.5,50,,53.2,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.09,39.17,,41.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,184.11,
INJECTION ADM VACCINE/TAXOID,11500019,CDM,760,RC,90471,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,73.04,
INJECTION TOXOID,11500020,CDM,760,RC,90471,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,44,50,,35.2,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,73.04,
IV START AND MONITOR 1ST HOUR,11500021,CDM,761,RC,96365,HCPCS,outpatient,,,344,172,,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,132.1,38.4,,105.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.1,38.4,,105.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,258,75,,206.4,percent of total billed charges,75% of total billed charges for outpatient setting,258,75,,206.4,percent of total billed charges,75% of total billed charges for outpatient setting,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,258,75,,206.4,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.4,35,,96.32,percent of total billed charges,35% of total billed charges for outpatient setting,268.32,78,,214.656,percent of total billed charges,78% of total billed charges for outpatient setting,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,240.8,70,,192.64,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258,75,,206.4,percent of total billed charges,75% of total billed charges for outpatient setting,285.52,83,,228.416,percent of total billed charges,83% of total billed charges for outpatient setting,172,50,,137.6,percent of total billed charges,50% of total billed charges for outpatient setting,172,50,,137.6,percent of total billed charges,50% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.74,39.17,,107.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,120.4,285.52,
IV MONITOR EACH ADDITIONAL HOU,11500022,CDM,761,RC,96366,HCPCS,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,20.65,48.97,
BONE MARROW ASPIRATE,11500024,CDM,360,RC,38220,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,1452,
BONE MARROW BIOPSY,11500025,CDM,360,RC,38221,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,1452,
CENTRAL LINE ARTERY,11500026,CDM,360,RC,36640,HCPCS,outpatient,,,4693,2346.5,,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1802.11,38.4,,1441.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1802.11,38.4,,1441.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,3519.75,75,,2815.8,percent of total billed charges,75% of total billed charges for outpatient setting,3519.75,75,,2815.8,percent of total billed charges,75% of total billed charges for outpatient setting,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,3519.75,75,,2815.8,percent of total billed charges,75% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1642.55,35,,1314.04,percent of total billed charges,35% of total billed charges for outpatient setting,3660.54,78,,2928.432,percent of total billed charges,78% of total billed charges for outpatient setting,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,3285.1,70,,2628.08,percent of total billed charges,70% of total billed charges for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3519.75,75,,2815.8,percent of total billed charges,75% of total billed charges for outpatient setting,3895.19,83,,3116.152,percent of total billed charges,83% of total billed charges for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3868,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1838.15,39.17,,1470.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2737.98,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1642.55,3895.19,
CENTRAL LINE VENOUS,11500027,CDM,360,RC,,,outpatient,,,165,82.5,,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.36,38.4,,50.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.75,35,,46.2,percent of total billed charges,35% of total billed charges for outpatient setting,128.7,78,,102.96,percent of total billed charges,78% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,70,,92.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123.75,75,,99,percent of total billed charges,75% of total billed charges for outpatient setting,136.95,83,,109.56,percent of total billed charges,83% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,82.5,50,,66,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.63,39.17,,51.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.75,136.95,
COLLECTION BLOOD/IMPLANTED DEV,11500028,CDM,360,RC,36591,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.7,659,
CONSCIOUS SEDATION  IM/IV/INHA,11500029,CDM,370,RC,,,outpatient,,,700,350,,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245,35,,196,percent of total billed charges,35% of total billed charges for outpatient setting,546,78,,436.8,percent of total billed charges,78% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,581,83,,464.8,percent of total billed charges,83% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.18,39.17,,219.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,245,581,
CONSCIOUS SEDATION ORAL/RECTAL,11500030,CDM,370,RC,,,outpatient,,,700,350,,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,268.8,38.4,,215.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245,35,,196,percent of total billed charges,35% of total billed charges for outpatient setting,546,78,,436.8,percent of total billed charges,78% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,490,70,,392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,525,75,,420,percent of total billed charges,75% of total billed charges for outpatient setting,581,83,,464.8,percent of total billed charges,83% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,350,50,,280,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.18,39.17,,219.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,245,581,
"INSERT CATH, RESIDUAL URINE",11500031,CDM,761,RC,51701,HCPCS,outpatient,,,197,98.5,,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,75.65,38.4,,60.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.65,38.4,,60.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.95,35,,55.16,percent of total billed charges,35% of total billed charges for outpatient setting,153.66,78,,122.928,percent of total billed charges,78% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,163.51,83,,130.808,percent of total billed charges,83% of total billed charges for outpatient setting,98.5,50,,78.8,percent of total billed charges,50% of total billed charges for outpatient setting,98.5,50,,78.8,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.16,39.17,,61.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.95,163.51,
"INSERT TEMP CATH, SIMPLE",11500032,CDM,761,RC,51703,HCPCS,outpatient,,,211,105.5,,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.02,38.4,,64.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,35,,59.08,percent of total billed charges,35% of total billed charges for outpatient setting,164.58,78,,131.664,percent of total billed charges,78% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,147.7,70,,118.16,percent of total billed charges,70% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.25,75,,126.6,percent of total billed charges,75% of total billed charges for outpatient setting,175.13,83,,140.104,percent of total billed charges,83% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,105.5,50,,84.4,percent of total billed charges,50% of total billed charges for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,82.64,39.17,,66.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,134.16,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,73.85,175.13,
IRRIGATION BLADDER,11500033,CDM,761,RC,51700,HCPCS,outpatient,,,422,211,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,35,,118.16,percent of total billed charges,35% of total billed charges for outpatient setting,329.16,78,,263.328,percent of total billed charges,78% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,350.26,83,,280.208,percent of total billed charges,83% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165.29,39.17,,132.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,350.26,
LUMBAR PUNCTURE,11500034,CDM,360,RC,62270,HCPCS,outpatient,,,708,354,,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.8,35,,198.24,percent of total billed charges,35% of total billed charges for outpatient setting,552.24,78,,441.792,percent of total billed charges,78% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,587.64,83,,470.112,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,277.31,39.17,,221.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.8,1452,
LUMBAR PUNCTURE THERAPEUTIC,11500035,CDM,360,RC,62272,HCPCS,outpatient,,,708,354,,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.8,35,,198.24,percent of total billed charges,35% of total billed charges for outpatient setting,552.24,78,,441.792,percent of total billed charges,78% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,587.64,83,,470.112,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,277.31,39.17,,221.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,594.02,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,247.8,1452,
THERAPEUTIC PHLIBOTOMY,11500036,CDM,300,RC,99195,HCPCS,outpatient,,,229,114.5,,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,87.94,38.4,,70.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.94,38.4,,70.352,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.15,35,,64.12,percent of total billed charges,35% of total billed charges for outpatient setting,178.62,78,,142.896,percent of total billed charges,78% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,160.3,70,,128.24,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.75,75,,137.4,percent of total billed charges,75% of total billed charges for outpatient setting,190.07,83,,152.056,percent of total billed charges,83% of total billed charges for outpatient setting,114.5,50,,91.6,percent of total billed charges,50% of total billed charges for outpatient setting,114.5,50,,91.6,percent of total billed charges,50% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,89.7,39.17,,71.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,80.15,190.07,
WOUND CARE SELECTIVE,11500037,CDM,510,RC,97601,HCPCS,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
WOUND CARE NON SELECTIVE,11500038,CDM,510,RC,97602,HCPCS,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,58.45,171.96,
DIRECT ADMIT OBS,11500039,CDM,762,RC,,,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65,70,,52,percent of total billed charges,70% of total billed charges for outpatient setting,65,70,,52,percent of total billed charges,70% of total billed charges for outpatient setting,65,70,,52,percent of total billed charges,70% of total billed charges for outpatient setting,65,75,,52,percent of total billed charges,75% of total billed charges for outpatient setting,65,75,,52,percent of total billed charges,75% of total billed charges for outpatient setting,65,70,,52,percent of total billed charges,70% of total billed charges for outpatient setting,65,75,,52,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,65,
PULSE OX,11500040,CDM,460,RC,94760,HCPCS,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,424,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,424,
INJECTION SQ,11500041,CDM,760,RC,96372,HCPCS,outpatient,,,74.27,37.14,,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,28.52,38.4,,22.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.52,38.4,,22.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,55.7,75,,44.56,percent of total billed charges,75% of total billed charges for outpatient setting,55.7,75,,44.56,percent of total billed charges,75% of total billed charges for outpatient setting,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,55.7,75,,44.56,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.99,35,,20.792,percent of total billed charges,35% of total billed charges for outpatient setting,57.93,78,,46.344,percent of total billed charges,78% of total billed charges for outpatient setting,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,51.99,70,,41.592,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,55.7,75,,44.56,percent of total billed charges,75% of total billed charges for outpatient setting,61.64,83,,49.312,percent of total billed charges,83% of total billed charges for outpatient setting,37.14,50,,29.712,percent of total billed charges,50% of total billed charges for outpatient setting,37.14,50,,29.712,percent of total billed charges,50% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,29.09,39.17,,23.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,25.99,61.64,
GASTRIC INTUBATION LAVAGE FOR,11500042,CDM,761,RC,91105,HCPCS,outpatient,,,67,33.5,,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.73,38.4,,20.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.73,38.4,,20.584,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.45,35,,18.76,percent of total billed charges,35% of total billed charges for outpatient setting,52.26,78,,41.808,percent of total billed charges,78% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,46.9,70,,37.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,50.25,75,,40.2,percent of total billed charges,75% of total billed charges for outpatient setting,55.61,83,,44.488,percent of total billed charges,83% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,33.5,50,,26.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.24,39.17,,20.992,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.45,55.61,
DEBRIDEMENT OF NAILS - 1 TO 5,11500043,CDM,360,RC,11720,HCPCS,outpatient,,,122,61,,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.85,38.4,,37.48,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,35,,34.16,percent of total billed charges,35% of total billed charges for outpatient setting,95.16,78,,76.128,percent of total billed charges,78% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,85.4,70,,68.32,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,91.5,75,,73.2,percent of total billed charges,75% of total billed charges for outpatient setting,101.26,83,,81.008,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,47.79,39.17,,38.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,42.7,659,
I & D LEG/ANKLE,11500044,CDM,360,RC,27603,HCPCS,outpatient,,,3139,1569.5,,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1205.38,38.4,,964.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1205.38,38.4,,964.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1098.65,35,,878.92,percent of total billed charges,35% of total billed charges for outpatient setting,2448.42,78,,1958.736,percent of total billed charges,78% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2605.37,83,,2084.296,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1229.49,39.17,,983.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1098.65,3141,
SUTURES 2.6 - 7.5 CM SIMPLE LA,11500045,CDM,361,RC,12052,HCPCS,outpatient,,,505,252.5,,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,193.92,38.4,,155.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,193.92,38.4,,155.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,378.75,75,,303,percent of total billed charges,75% of total billed charges for outpatient setting,378.75,75,,303,percent of total billed charges,75% of total billed charges for outpatient setting,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,378.75,75,,303,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.75,35,,141.4,percent of total billed charges,35% of total billed charges for outpatient setting,393.9,78,,315.12,percent of total billed charges,78% of total billed charges for outpatient setting,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,353.5,70,,282.8,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,378.75,75,,303,percent of total billed charges,75% of total billed charges for outpatient setting,419.15,83,,335.32,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,197.8,39.17,,158.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,176.75,659,
DILATE URETHRA STRICTURE,11500046,CDM,361,RC,53600,HCPCS,outpatient,,,422,211,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,35,,118.16,percent of total billed charges,35% of total billed charges for outpatient setting,329.16,78,,263.328,percent of total billed charges,78% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,350.26,83,,280.208,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,165.29,39.17,,132.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.7,659,
I & D COMPLEX POST OP WOUND,11500047,CDM,361,RC,10180,HCPCS,outpatient,,,3139,1569.5,,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1205.38,38.4,,964.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1205.38,38.4,,964.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1098.65,35,,878.92,percent of total billed charges,35% of total billed charges for outpatient setting,2448.42,78,,1958.736,percent of total billed charges,78% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2197.3,70,,1757.84,percent of total billed charges,70% of total billed charges for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2354.25,75,,1883.4,percent of total billed charges,75% of total billed charges for outpatient setting,2605.37,83,,2084.296,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1229.49,39.17,,983.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,2440.78,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1098.65,3141,
PARACENTESIS/THORACENTESIS,11500048,CDM,361,RC,,,outpatient,,,200,100,,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.8,38.4,,61.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70,35,,56,percent of total billed charges,35% of total billed charges for outpatient setting,156,78,,124.8,percent of total billed charges,78% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,140,70,,112,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,166,83,,132.8,percent of total billed charges,83% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,100,50,,80,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.34,39.17,,62.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70,166,
TREATMENT ROOM 0-8,11500049,CDM,761,RC,,,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
TREATMENT ROOM LEVEL 4,11500050,CDM,510,RC,99204,HCPCS,outpatient,,,320,160,,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.88,38.4,,98.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112,35,,89.6,percent of total billed charges,35% of total billed charges for outpatient setting,249.6,78,,199.68,percent of total billed charges,78% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,224,70,,179.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,240,75,,192,percent of total billed charges,75% of total billed charges for outpatient setting,265.6,83,,212.48,percent of total billed charges,83% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,160,50,,128,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.34,39.17,,100.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,112,265.6,
REPLACE GASTROSTOMY TUBE,11500051,CDM,761,RC,43246,HCPCS,outpatient,,,720,360,,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,276.48,38.4,,221.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,276.48,38.4,,221.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,540,75,,432,percent of total billed charges,75% of total billed charges for outpatient setting,540,75,,432,percent of total billed charges,75% of total billed charges for outpatient setting,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,540,75,,432,percent of total billed charges,75% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252,35,,201.6,percent of total billed charges,35% of total billed charges for outpatient setting,561.6,78,,449.28,percent of total billed charges,78% of total billed charges for outpatient setting,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,504,70,,403.2,percent of total billed charges,70% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,540,75,,432,percent of total billed charges,75% of total billed charges for outpatient setting,597.6,83,,478.08,percent of total billed charges,83% of total billed charges for outpatient setting,360,50,,288,percent of total billed charges,50% of total billed charges for outpatient setting,360,50,,288,percent of total billed charges,50% of total billed charges for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,282.01,39.17,,225.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1634.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,252,1634.48,
ASPIRATION/INJECTION ELBOW,11500052,CDM,760,RC,20605,HCPCS,outpatient,,,404,202,,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,155.14,38.4,,124.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.14,38.4,,124.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,303,75,,242.4,percent of total billed charges,75% of total billed charges for outpatient setting,303,75,,242.4,percent of total billed charges,75% of total billed charges for outpatient setting,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,303,75,,242.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.4,35,,113.12,percent of total billed charges,35% of total billed charges for outpatient setting,315.12,78,,252.096,percent of total billed charges,78% of total billed charges for outpatient setting,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,282.8,70,,226.24,percent of total billed charges,70% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,303,75,,242.4,percent of total billed charges,75% of total billed charges for outpatient setting,335.32,83,,268.256,percent of total billed charges,83% of total billed charges for outpatient setting,202,50,,161.6,percent of total billed charges,50% of total billed charges for outpatient setting,202,50,,161.6,percent of total billed charges,50% of total billed charges for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,158.24,39.17,,126.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,254.41,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,141.4,335.32,
CATHERIZATION SIMPLE,11500053,CDM,360,RC,51702,HCPCS,outpatient,,,197,98.5,,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,75.65,38.4,,60.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.65,38.4,,60.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.95,35,,55.16,percent of total billed charges,35% of total billed charges for outpatient setting,153.66,78,,122.928,percent of total billed charges,78% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,137.9,70,,110.32,percent of total billed charges,70% of total billed charges for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,147.75,75,,118.2,percent of total billed charges,75% of total billed charges for outpatient setting,163.51,83,,130.808,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.16,39.17,,61.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,109.72,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,68.95,659,
IV INFUSION HYDRATION,11500054,CDM,260,RC,96360,HCPCS,outpatient,,,133,66.5,,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.07,38.4,,40.856,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,35,,37.24,percent of total billed charges,35% of total billed charges for outpatient setting,103.74,78,,82.992,percent of total billed charges,78% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,93.1,70,,74.48,percent of total billed charges,70% of total billed charges for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,99.75,75,,79.8,percent of total billed charges,75% of total billed charges for outpatient setting,110.39,83,,88.312,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.09,39.17,,41.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,184.11,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,46.55,212,
IV HYDRATION EACH ADD HOUR,11500055,CDM,260,RC,96361,HCPCS,outpatient,,,37.29,18.65,,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,14.32,38.4,,11.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.32,38.4,,11.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.97,75,,22.376,percent of total billed charges,75% of total billed charges for outpatient setting,27.97,75,,22.376,percent of total billed charges,75% of total billed charges for outpatient setting,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,27.97,75,,22.376,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,35,,10.44,percent of total billed charges,35% of total billed charges for outpatient setting,29.09,78,,23.272,percent of total billed charges,78% of total billed charges for outpatient setting,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,26.1,70,,20.88,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,27.97,75,,22.376,percent of total billed charges,75% of total billed charges for outpatient setting,30.95,83,,24.76,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,14.61,39.17,,11.688,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,13.05,212,
IRRIGATION OF IMPLANTED DEVICE,11500056,CDM,510,RC,96523,HCPCS,outpatient,,,162,81,,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.21,38.4,,49.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,56.7,35,,45.36,percent of total billed charges,35% of total billed charges for outpatient setting,126.36,78,,101.088,percent of total billed charges,78% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,113.4,70,,90.72,percent of total billed charges,70% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,121.5,75,,97.2,percent of total billed charges,75% of total billed charges for outpatient setting,134.46,83,,107.568,percent of total billed charges,83% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,81,50,,64.8,percent of total billed charges,50% of total billed charges for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,63.45,39.17,,50.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,52.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,52.54,134.46,
GASTROSTOMY TUBE CHANGE,11500057,CDM,360,RC,43762,HCPCS,outpatient,,,184,92,,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.66,38.4,,56.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.4,35,,51.52,percent of total billed charges,35% of total billed charges for outpatient setting,143.52,78,,114.816,percent of total billed charges,78% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,128.8,70,,103.04,percent of total billed charges,70% of total billed charges for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,138,75,,110.4,percent of total billed charges,75% of total billed charges for outpatient setting,152.72,83,,122.176,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,72.07,39.17,,57.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,212.29,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,64.4,659,
ADDITIONAL IV PUSH NEW MED,11500059,CDM,260,RC,96375,HCPCS,outpatient,,,103.81,51.91,,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,39.86,38.4,,31.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.86,38.4,,31.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,77.86,75,,62.288,percent of total billed charges,75% of total billed charges for outpatient setting,77.86,75,,62.288,percent of total billed charges,75% of total billed charges for outpatient setting,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,77.86,75,,62.288,percent of total billed charges,75% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,35,,29.064,percent of total billed charges,35% of total billed charges for outpatient setting,80.97,78,,64.776,percent of total billed charges,78% of total billed charges for outpatient setting,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,72.67,70,,58.136,percent of total billed charges,70% of total billed charges for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,77.86,75,,62.288,percent of total billed charges,75% of total billed charges for outpatient setting,86.16,83,,68.928,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,40.66,39.17,,32.528,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,40.79,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,36.33,212,
"DEBRIDEMENT SKIN,SQ TISSUE,MUS",11500061,CDM,761,RC,11043,HCPCS,outpatient,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,275,50,,220,percent of total billed charges,50% of total billed charges for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,539.48,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.5,539.48,
BEDSIDE MINOR PROCEDURE,11500062,CDM,761,RC,,,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
I & D ABSCESS @ BEDSIDE,11500063,CDM,360,RC,10060,HCPCS,outpatient,,,319,159.5,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,35,,89.32,percent of total billed charges,35% of total billed charges for outpatient setting,248.82,78,,199.056,percent of total billed charges,78% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,264.77,83,,211.816,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.95,39.17,,99.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,659,
FINE NEEDLE ASPIRATION W/O IMA,11500064,CDM,360,RC,10021,HCPCS,outpatient,,,295,147.5,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.25,35,,82.6,percent of total billed charges,35% of total billed charges for outpatient setting,230.1,78,,184.08,percent of total billed charges,78% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,244.85,83,,195.88,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.55,39.17,,92.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.25,659,
CYSTOSTOMY W/INSERTION OF CATH,11500065,CDM,360,RC,51102,HCPCS,outpatient,,,2838,1419,,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,1749.58,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1089.79,38.4,,871.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1089.79,38.4,,871.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,2128.5,75,,1702.8,percent of total billed charges,75% of total billed charges for outpatient setting,2128.5,75,,1702.8,percent of total billed charges,75% of total billed charges for outpatient setting,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,2128.5,75,,1702.8,percent of total billed charges,75% of total billed charges for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,993.3,35,,794.64,percent of total billed charges,35% of total billed charges for outpatient setting,2213.64,78,,1770.912,percent of total billed charges,78% of total billed charges for outpatient setting,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,1986.6,70,,1589.28,percent of total billed charges,70% of total billed charges for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,2128.5,75,,1702.8,percent of total billed charges,75% of total billed charges for outpatient setting,2355.54,83,,1884.432,percent of total billed charges,83% of total billed charges for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,3141,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1111.59,39.17,,889.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1749.58,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,993.3,3141,
DEBRIDEMENT SKIN AND SUBCUT TI,11500066,CDM,360,RC,11042,HCPCS,outpatient,,,550,275,,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,211.2,38.4,,168.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.5,35,,154,percent of total billed charges,35% of total billed charges for outpatient setting,429,78,,343.2,percent of total billed charges,78% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,385,70,,308,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,412.5,75,,330,percent of total billed charges,75% of total billed charges for outpatient setting,456.5,83,,365.2,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,215.42,39.17,,172.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,192.5,659,
INSERTION PERIPHERALLY INSRTED,11500067,CDM,360,RC,36569,HCPCS,outpatient,,,4200,2100,,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,1612.8,38.4,,1290.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1612.8,38.4,,1290.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1470,35,,1176,percent of total billed charges,35% of total billed charges for outpatient setting,3276,78,,2620.8,percent of total billed charges,78% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,2940,70,,2352,percent of total billed charges,70% of total billed charges for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,3150,75,,2520,percent of total billed charges,75% of total billed charges for outpatient setting,3486,83,,2788.8,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1645.06,39.17,,1316.048,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,3486,
DRAINAGE OF SCROTUM ABSCESS AT,11500068,CDM,360,RC,55100,HCPCS,outpatient,,,1689,844.5,,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,648.58,38.4,,518.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,648.58,38.4,,518.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.15,35,,472.92,percent of total billed charges,35% of total billed charges for outpatient setting,1317.42,78,,1053.936,percent of total billed charges,78% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1182.3,70,,945.84,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1266.75,75,,1013.4,percent of total billed charges,75% of total billed charges for outpatient setting,1401.87,83,,1121.496,percent of total billed charges,83% of total billed charges for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,2175,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,661.55,39.17,,529.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,591.15,2175,
"BIOPSY, SKIN LESION",11500069,CDM,360,RC,11100,HCPCS,outpatient,,,295,147.5,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.25,35,,82.6,percent of total billed charges,35% of total billed charges for outpatient setting,230.1,78,,184.08,percent of total billed charges,78% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,244.85,83,,195.88,percent of total billed charges,83% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,147.5,50,,118,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.55,39.17,,92.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,103.25,244.85,
"BIOPSY, SKIN LESION EACH ADDIT",11500070,CDM,360,RC,11101,HCPCS,outpatient,,,82,41,,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.49,38.4,,25.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.7,35,,22.96,percent of total billed charges,35% of total billed charges for outpatient setting,63.96,78,,51.168,percent of total billed charges,78% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,57.4,70,,45.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.5,75,,49.2,percent of total billed charges,75% of total billed charges for outpatient setting,68.06,83,,54.448,percent of total billed charges,83% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,41,50,,32.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.12,39.17,,25.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28.7,68.06,
DEBRIDEMENT SKIN/MUSCLE/BONE A,11500071,CDM,360,RC,11044,HCPCS,outpatient,,,1282,641,,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.29,38.4,,393.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,35,,358.96,percent of total billed charges,35% of total billed charges for outpatient setting,999.96,78,,799.968,percent of total billed charges,78% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,897.4,70,,717.92,percent of total billed charges,70% of total billed charges for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,961.5,75,,769.2,percent of total billed charges,75% of total billed charges for outpatient setting,1064.06,83,,851.248,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,502.14,39.17,,401.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,1392.65,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,448.7,1452,
BIOPSY OF VULVA PERINEUM,11500072,CDM,360,RC,56605,HCPCS,outpatient,,,738,369,,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,690.54,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,283.39,38.4,,226.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,283.39,38.4,,226.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,553.5,75,,442.8,percent of total billed charges,75% of total billed charges for outpatient setting,553.5,75,,442.8,percent of total billed charges,75% of total billed charges for outpatient setting,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,553.5,75,,442.8,percent of total billed charges,75% of total billed charges for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.3,35,,206.64,percent of total billed charges,35% of total billed charges for outpatient setting,575.64,78,,460.512,percent of total billed charges,78% of total billed charges for outpatient setting,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,516.6,70,,413.28,percent of total billed charges,70% of total billed charges for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,553.5,75,,442.8,percent of total billed charges,75% of total billed charges for outpatient setting,612.54,83,,490.032,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,289.06,39.17,,231.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,690.54,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,258.3,1452,
PUNCTURE DRAINAGE OF LESION,11500073,CDM,360,RC,10160,HCPCS,outpatient,,,319,159.5,,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,122.5,38.4,,98,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,35,,89.32,percent of total billed charges,35% of total billed charges for outpatient setting,248.82,78,,199.056,percent of total billed charges,78% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,223.3,70,,178.64,percent of total billed charges,70% of total billed charges for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,239.25,75,,191.4,percent of total billed charges,75% of total billed charges for outpatient setting,264.77,83,,211.816,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,124.95,39.17,,99.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,342.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,111.65,659,
REMOVAL DEVITAL TISSUE,11500074,CDM,360,RC,97597,HCPCS,outpatient,,,295,147.5,,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,113.28,38.4,,90.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.25,35,,82.6,percent of total billed charges,35% of total billed charges for outpatient setting,230.1,78,,184.08,percent of total billed charges,78% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,206.5,70,,165.2,percent of total billed charges,70% of total billed charges for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,221.25,75,,177,percent of total billed charges,75% of total billed charges for outpatient setting,244.85,83,,195.88,percent of total billed charges,83% of total billed charges for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,659,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,115.55,39.17,,92.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,171.96,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,103.25,659,
DRAINAGE OF PERITONEAL ABSCESS,11500075,CDM,360,RC,49021,HCPCS,outpatient,,,1622,811,,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,622.85,38.4,,498.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,622.85,38.4,,498.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,1216.5,75,,973.2,percent of total billed charges,75% of total billed charges for outpatient setting,1216.5,75,,973.2,percent of total billed charges,75% of total billed charges for outpatient setting,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,1216.5,75,,973.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,567.7,35,,454.16,percent of total billed charges,35% of total billed charges for outpatient setting,1265.16,78,,1012.128,percent of total billed charges,78% of total billed charges for outpatient setting,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,1135.4,70,,908.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1216.5,75,,973.2,percent of total billed charges,75% of total billed charges for outpatient setting,1346.26,83,,1077.008,percent of total billed charges,83% of total billed charges for outpatient setting,811,50,,648.8,percent of total billed charges,50% of total billed charges for outpatient setting,811,50,,648.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,635.31,39.17,,508.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,567.7,1346.26,
"PROCTOSIGMOIDOSCOPY, DX AT BED",11500076,CDM,360,RC,45300,HCPCS,outpatient,,,922,461,,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,354.05,38.4,,283.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,354.05,38.4,,283.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,691.5,75,,553.2,percent of total billed charges,75% of total billed charges for outpatient setting,691.5,75,,553.2,percent of total billed charges,75% of total billed charges for outpatient setting,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,691.5,75,,553.2,percent of total billed charges,75% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,322.7,35,,258.16,percent of total billed charges,35% of total billed charges for outpatient setting,719.16,78,,575.328,percent of total billed charges,78% of total billed charges for outpatient setting,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,645.4,70,,516.32,percent of total billed charges,70% of total billed charges for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,691.5,75,,553.2,percent of total billed charges,75% of total billed charges for outpatient setting,765.26,83,,612.208,percent of total billed charges,83% of total billed charges for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,361.13,39.17,,288.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,785.07,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,322.7,1452,
IV INFUSION ADD SEQUENTIAL INF,11500077,CDM,260,RC,96367,HCPCS,outpatient,,,88,44,,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.79,38.4,,27.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,35,,24.64,percent of total billed charges,35% of total billed charges for outpatient setting,68.64,78,,54.912,percent of total billed charges,78% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,61.6,70,,49.28,percent of total billed charges,70% of total billed charges for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,66,75,,52.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.04,83,,58.432,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,34.47,39.17,,27.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,60.51,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,30.8,212,
IV PUSH SAME MED AFTER 30 MIN,11500078,CDM,260,RC,96376,HCPCS,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,212,100,,,case rate,100% UHC case rate for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,212,
ULTRASOUND GUIDED BIOPSY,11500079,CDM,360,RC,,,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
BAM INFUSION,11500080,CDM,771,RC,M0245,HCPCS,outpatient,,,703,351.5,,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,246.05,35,,196.84,percent of total billed charges,35% of total billed charges for outpatient setting,548.34,78,,438.672,percent of total billed charges,78% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,583.49,83,,466.792,percent of total billed charges,83% of total billed charges for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,275.35,39.17,,220.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106,583.49,
REGENERON MONOCLONAL ANTIBODY INFUSION,11500081,CDM,771,RC,M0243,HCPCS,outpatient,,,1305,652.5,,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456.75,35,,365.4,percent of total billed charges,35% of total billed charges for outpatient setting,1017.9,78,,814.32,percent of total billed charges,78% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,1083.15,83,,866.52,percent of total billed charges,83% of total billed charges for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,511.14,39.17,,408.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106,1083.15,
BAMLAN AND ESTESEV  ANTIBODY INFUSION,11500082,CDM,771,RC,M0245,HCPCS,outpatient,,,1305,652.5,,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456.75,35,,365.4,percent of total billed charges,35% of total billed charges for outpatient setting,1017.9,78,,814.32,percent of total billed charges,78% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,1083.15,83,,866.52,percent of total billed charges,83% of total billed charges for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,511.14,39.17,,408.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106,1083.15,
SOTROVIMAB INFUSION,11500083,CDM,771,RC,M0247,HCPCS,outpatient,,,1305,652.5,,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,501.12,38.4,,400.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,456.75,35,,365.4,percent of total billed charges,35% of total billed charges for outpatient setting,1017.9,78,,814.32,percent of total billed charges,78% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,913.5,70,,730.8,percent of total billed charges,70% of total billed charges for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,978.75,75,,783,percent of total billed charges,75% of total billed charges for outpatient setting,1083.15,83,,866.52,percent of total billed charges,83% of total billed charges for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,106,100,,,case rate,100% UHC case rate for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,511.14,39.17,,408.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,406.14,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,106,1083.15,
SWABSTICK  - IODINE POVIDONE,80000034,CDM,360,RC,93503,HCPCS,outpatient,,,,,,,,,,other,Not separately reimursable due to charge amount,1375.68,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,,,,,other,Not separately reimbursable for outpatient setting due to charge amount,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1452,100,,,fee schedule,100% UHC ASC group fee schedule rate for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1375.68,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,1375.68,1452,
DRESSING - 4X4 BORDER MSC3244Z,80000218,CDM,270,RC,,,outpatient,,,1.2,0.6,,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.46,38.4,,0.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.46,38.4,,0.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,0.9,75,,0.72,percent of total billed charges,75% of total billed charges for outpatient setting,0.9,75,,0.72,percent of total billed charges,75% of total billed charges for outpatient setting,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,0.9,75,,0.72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.42,35,,0.336,percent of total billed charges,35% of total billed charges for outpatient setting,0.94,78,,0.752,percent of total billed charges,78% of total billed charges for outpatient setting,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,0.84,70,,0.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.9,75,,0.72,percent of total billed charges,75% of total billed charges for outpatient setting,1,83,,0.8,percent of total billed charges,83% of total billed charges for outpatient setting,0.6,50,,0.48,percent of total billed charges,50% of total billed charges for outpatient setting,0.6,50,,0.48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.47,39.17,,0.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.42,1,
J-HOOK - DISP LAP ELECTRODE 33,80000328,CDM,270,RC,,,outpatient,,,1575,787.5,,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,604.8,38.4,,483.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,604.8,38.4,,483.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,1181.25,75,,945,percent of total billed charges,75% of total billed charges for outpatient setting,1181.25,75,,945,percent of total billed charges,75% of total billed charges for outpatient setting,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,1181.25,75,,945,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,551.25,35,,441,percent of total billed charges,35% of total billed charges for outpatient setting,1228.5,78,,982.8,percent of total billed charges,78% of total billed charges for outpatient setting,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,1102.5,70,,882,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1181.25,75,,945,percent of total billed charges,75% of total billed charges for outpatient setting,1307.25,83,,1045.8,percent of total billed charges,83% of total billed charges for outpatient setting,787.5,50,,630,percent of total billed charges,50% of total billed charges for outpatient setting,787.5,50,,630,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,616.9,39.17,,493.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,551.25,1307.25,
NEEDLE - 21GA X 1.5 NON-SAFETY,80000395,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
OINTMENT - REMEDY PHYTOPLEX ANTIFUNGAL,80000751,CDM,270,RC,,,outpatient,,,6.55,3.28,,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.52,38.4,,2.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.52,38.4,,2.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,4.91,75,,3.928,percent of total billed charges,75% of total billed charges for outpatient setting,4.91,75,,3.928,percent of total billed charges,75% of total billed charges for outpatient setting,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,4.91,75,,3.928,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.29,35,,1.832,percent of total billed charges,35% of total billed charges for outpatient setting,5.11,78,,4.088,percent of total billed charges,78% of total billed charges for outpatient setting,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,4.59,70,,3.672,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.91,75,,3.928,percent of total billed charges,75% of total billed charges for outpatient setting,5.44,83,,4.352,percent of total billed charges,83% of total billed charges for outpatient setting,3.28,50,,2.624,percent of total billed charges,50% of total billed charges for outpatient setting,3.28,50,,2.624,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.57,39.17,,2.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.29,5.44,
GEL - SILVASORB SILVER ANTIMICROB WOUND,80000752,CDM,270,RC,,,outpatient,,,11.42,5.71,,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.39,38.4,,3.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.39,38.4,,3.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,8.57,75,,6.856,percent of total billed charges,75% of total billed charges for outpatient setting,8.57,75,,6.856,percent of total billed charges,75% of total billed charges for outpatient setting,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,8.57,75,,6.856,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4,35,,3.2,percent of total billed charges,35% of total billed charges for outpatient setting,8.91,78,,7.128,percent of total billed charges,78% of total billed charges for outpatient setting,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,7.99,70,,6.392,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.57,75,,6.856,percent of total billed charges,75% of total billed charges for outpatient setting,9.48,83,,7.584,percent of total billed charges,83% of total billed charges for outpatient setting,5.71,50,,4.568,percent of total billed charges,50% of total billed charges for outpatient setting,5.71,50,,4.568,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.48,39.17,,3.584,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4,9.48,
CLEANSER - 8OZ WOUND INTEGRITY SPRAY,80000753,CDM,270,RC,,,outpatient,,,8.88,4.44,,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.41,38.4,,2.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.41,38.4,,2.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,6.66,75,,5.328,percent of total billed charges,75% of total billed charges for outpatient setting,6.66,75,,5.328,percent of total billed charges,75% of total billed charges for outpatient setting,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,6.66,75,,5.328,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.11,35,,2.488,percent of total billed charges,35% of total billed charges for outpatient setting,6.93,78,,5.544,percent of total billed charges,78% of total billed charges for outpatient setting,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,6.22,70,,4.976,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,75,,5.328,percent of total billed charges,75% of total billed charges for outpatient setting,7.37,83,,5.896,percent of total billed charges,83% of total billed charges for outpatient setting,4.44,50,,3.552,percent of total billed charges,50% of total billed charges for outpatient setting,4.44,50,,3.552,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.48,39.17,,2.784,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.11,7.37,
HYDROGEL - SKINTEGRITY 1OZ BELLE BTL,80000754,CDM,270,RC,,,outpatient,,,2.72,1.36,,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.04,38.4,,0.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.04,38.4,,0.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,2.04,75,,1.632,percent of total billed charges,75% of total billed charges for outpatient setting,2.04,75,,1.632,percent of total billed charges,75% of total billed charges for outpatient setting,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,2.04,75,,1.632,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,0.95,35,,0.76,percent of total billed charges,35% of total billed charges for outpatient setting,2.12,78,,1.696,percent of total billed charges,78% of total billed charges for outpatient setting,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,1.9,70,,1.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.04,75,,1.632,percent of total billed charges,75% of total billed charges for outpatient setting,2.26,83,,1.808,percent of total billed charges,83% of total billed charges for outpatient setting,1.36,50,,1.088,percent of total billed charges,50% of total billed charges for outpatient setting,1.36,50,,1.088,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.06,39.17,,0.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,0.95,2.26,
DRESSING TELFA 8X3,90000001,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
DRESSING TELFA 4X5,90000002,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
SPLINT - LG LT PD FOREARM,90000004,CDM,274,RC,L3807,HCPCS,both,,,317,158.5,,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.73,38.4,,97.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,121.73,38.4,,97.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,317,70,,253.6,percent of total billed charges,70% of total billed charges for outpatient setting,317,70,,253.6,percent of total billed charges,70% of total billed charges for outpatient setting,317,70,,253.6,percent of total billed charges,70% of total billed charges for outpatient setting,317,75,,253.6,percent of total billed charges,75% of total billed charges for outpatient setting,317,75,,253.6,percent of total billed charges,75% of total billed charges for outpatient setting,317,70,,253.6,percent of total billed charges,70% of total billed charges for outpatient setting,317,75,,253.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.95,35,,88.76,percent of total billed charges,35% of total billed charges for outpatient setting,247.26,78,,197.808,percent of total billed charges,78% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,221.9,70,,177.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,237.75,75,,190.2,percent of total billed charges,75% of total billed charges for outpatient setting,263.11,83,,210.488,percent of total billed charges,83% of total billed charges for outpatient setting,158.5,50,,126.8,percent of total billed charges,50% of total billed charges for outpatient setting,158.5,50,,126.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,124.16,39.17,,99.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,110.95,317,
COLLAR - MD FORM FIT CERVICAL,90000006,CDM,274,RC,L0120,HCPCS,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
COLLAR - LG FORM FIT CERVICAL,90000007,CDM,274,RC,L0120,HCPCS,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
AIRWAY 28FR NASAL ROBERTAZZI,90000015,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
AIRWAY 30FR NASAL ROBERTAZZI,90000016,CDM,270,RC,,,outpatient,,,72,36,,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.65,38.4,,22.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.65,38.4,,22.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.2,35,,20.16,percent of total billed charges,35% of total billed charges for outpatient setting,56.16,78,,44.928,percent of total billed charges,78% of total billed charges for outpatient setting,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,50.4,70,,40.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54,75,,43.2,percent of total billed charges,75% of total billed charges for outpatient setting,59.76,83,,47.808,percent of total billed charges,83% of total billed charges for outpatient setting,36,50,,28.8,percent of total billed charges,50% of total billed charges for outpatient setting,36,50,,28.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.2,39.17,,22.56,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.2,59.76,
AIRWAY 20FR NASAL ROBERTAZZI,90000017,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
AIRWAY 24FR NASAL ROBERTAZZI,90000018,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
AIRWAY 26FR NASAL ROBERTAZZI,90000019,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
AIRWAY 22FR NASAL ROBERTAZZI,90000020,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
AIRWAY 34FR NASAL ROBERTAZZI,90000021,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
AIRWAY 36FR NASAL ROBERTAZZI,90000022,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
SPLINT - RT S/M THUMB,90000023,CDM,274,RC,L3923,HCPCS,both,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,89,
SPLINT-SM FINGER/THUMB,90000024,CDM,274,RC,L3923,HCPCS,both,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,89,
SPLINT-LG FINGER/THUMB,90000025,CDM,274,RC,L3923,HCPCS,both,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,89,70,,71.2,percent of total billed charges,70% of total billed charges for outpatient setting,89,75,,71.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,89,
THUMBSPICA-LT S/M,90000026,CDM,270,RC,L3923,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,73.87,
THUMBSPICA-RT L/XL,90000027,CDM,270,RC,L3923,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,73.87,
THUMBSPICA-LT L/XL,90000028,CDM,270,RC,L3923,HCPCS,outpatient,,,89,44.5,,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.18,38.4,,27.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.15,35,,24.92,percent of total billed charges,35% of total billed charges for outpatient setting,69.42,78,,55.536,percent of total billed charges,78% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,62.3,70,,49.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.75,75,,53.4,percent of total billed charges,75% of total billed charges for outpatient setting,73.87,83,,59.096,percent of total billed charges,83% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,44.5,50,,35.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.86,39.17,,27.888,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.15,73.87,
SPLINT-MD FINGER/THUMB,90000029,CDM,274,RC,L3923,HCPCS,both,,,124,62,,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,47.62,38.4,,38.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,124,70,,99.2,percent of total billed charges,70% of total billed charges for outpatient setting,124,70,,99.2,percent of total billed charges,70% of total billed charges for outpatient setting,124,70,,99.2,percent of total billed charges,70% of total billed charges for outpatient setting,124,75,,99.2,percent of total billed charges,75% of total billed charges for outpatient setting,124,75,,99.2,percent of total billed charges,75% of total billed charges for outpatient setting,124,70,,99.2,percent of total billed charges,70% of total billed charges for outpatient setting,124,75,,99.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.4,35,,34.72,percent of total billed charges,35% of total billed charges for outpatient setting,96.72,78,,77.376,percent of total billed charges,78% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,86.8,70,,69.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93,75,,74.4,percent of total billed charges,75% of total billed charges for outpatient setting,102.92,83,,82.336,percent of total billed charges,83% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,62,50,,49.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.57,39.17,,38.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.4,124,
STRIP - .25X5YD IODOFORM PACKI,90000036,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
WEDGE - POMMELL,90000037,CDM,270,RC,,,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.45,138.61,
TUBE - 4OZ BIOFREEZE,90000038,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
SKINSLEEVE - SM ARM LIGHT TONE,90000039,CDM,270,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
SKINSLEEVE - MD LEG LIGHT TONE,90000040,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
DRAIN - 1310 7MM JP,90000048,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
STAPLER - TLC 55-3.8 MULTIFIRE,90000050,CDM,270,RC,,,outpatient,,,314,157,,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.58,38.4,,96.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,120.58,38.4,,96.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.9,35,,87.92,percent of total billed charges,35% of total billed charges for outpatient setting,244.92,78,,195.936,percent of total billed charges,78% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,219.8,70,,175.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,235.5,75,,188.4,percent of total billed charges,75% of total billed charges for outpatient setting,260.62,83,,208.496,percent of total billed charges,83% of total billed charges for outpatient setting,157,50,,125.6,percent of total billed charges,50% of total billed charges for outpatient setting,157,50,,125.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.99,39.17,,98.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,109.9,260.62,
SHELLS - THERA,90000051,CDM,270,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
DRAIN - .5  PENROSE 18 LONG,90000052,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
ENDO AVITENE 5MM,90000053,CDM,270,RC,,,outpatient,,,328,164,,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.8,35,,91.84,percent of total billed charges,35% of total billed charges for outpatient setting,255.84,78,,204.672,percent of total billed charges,78% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,272.24,83,,217.792,percent of total billed charges,83% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.47,39.17,,102.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.8,272.24,
REFILL - TCR55 60-3.8 GIA,90000054,CDM,270,RC,,,outpatient,,,193,96.5,,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.11,38.4,,59.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,74.11,38.4,,59.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.55,35,,54.04,percent of total billed charges,35% of total billed charges for outpatient setting,150.54,78,,120.432,percent of total billed charges,78% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,135.1,70,,108.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.75,75,,115.8,percent of total billed charges,75% of total billed charges for outpatient setting,160.19,83,,128.152,percent of total billed charges,83% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,96.5,50,,77.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.59,39.17,,60.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,67.55,160.19,
SYSTEM 10MM INZII RETRIEVAL,90000055,CDM,270,RC,,,outpatient,,,263,131.5,,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,100.99,38.4,,80.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,100.99,38.4,,80.792,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,197.25,75,,157.8,percent of total billed charges,75% of total billed charges for outpatient setting,197.25,75,,157.8,percent of total billed charges,75% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,197.25,75,,157.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.05,35,,73.64,percent of total billed charges,35% of total billed charges for outpatient setting,205.14,78,,164.112,percent of total billed charges,78% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,184.1,70,,147.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,197.25,75,,157.8,percent of total billed charges,75% of total billed charges for outpatient setting,218.29,83,,174.632,percent of total billed charges,83% of total billed charges for outpatient setting,131.5,50,,105.2,percent of total billed charges,50% of total billed charges for outpatient setting,131.5,50,,105.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,103.01,39.17,,82.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,92.05,218.29,
CATH - 12FR RED RUBBER,90000056,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
CATH - 14FR RED RUBBER,90000057,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SAMPLER - ENDOMETRIAL CELL,90000058,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
REFILL - 30-3.5 TA,90000059,CDM,270,RC,,,outpatient,,,189,94.5,,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.58,38.4,,58.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.58,38.4,,58.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,141.75,75,,113.4,percent of total billed charges,75% of total billed charges for outpatient setting,141.75,75,,113.4,percent of total billed charges,75% of total billed charges for outpatient setting,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,141.75,75,,113.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.15,35,,52.92,percent of total billed charges,35% of total billed charges for outpatient setting,147.42,78,,117.936,percent of total billed charges,78% of total billed charges for outpatient setting,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,132.3,70,,105.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,141.75,75,,113.4,percent of total billed charges,75% of total billed charges for outpatient setting,156.87,83,,125.496,percent of total billed charges,83% of total billed charges for outpatient setting,94.5,50,,75.6,percent of total billed charges,50% of total billed charges for outpatient setting,94.5,50,,75.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.03,39.17,,59.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.15,156.87,
LOOP - CHROMIC GUT SURGITIE,90000061,CDM,270,RC,,,outpatient,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.9,35,,43.12,percent of total billed charges,35% of total billed charges for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.32,39.17,,48.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.9,127.82,
LOOP - PLAIN GUT SURGITIE,90000062,CDM,270,RC,,,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21,49.8,
DRESSING - IOBAN 2 STERI-DRAPE,90000063,CDM,270,RC,,,outpatient,,,93,46.5,,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.71,38.4,,28.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.55,35,,26.04,percent of total billed charges,35% of total billed charges for outpatient setting,72.54,78,,58.032,percent of total billed charges,78% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,65.1,70,,52.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.75,75,,55.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.19,83,,61.752,percent of total billed charges,83% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,46.5,50,,37.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.42,39.17,,29.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,32.55,77.19,
INSTRUMENT - PURSTRING 45,90000064,CDM,270,RC,,,outpatient,,,450,225,,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,172.8,38.4,,138.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,172.8,38.4,,138.24,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.5,35,,126,percent of total billed charges,35% of total billed charges for outpatient setting,351,78,,280.8,percent of total billed charges,78% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,315,70,,252,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,337.5,75,,270,percent of total billed charges,75% of total billed charges for outpatient setting,373.5,83,,298.8,percent of total billed charges,83% of total billed charges for outpatient setting,225,50,,180,percent of total billed charges,50% of total billed charges for outpatient setting,225,50,,180,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,176.26,39.17,,141.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,157.5,373.5,
NEEDLE - 15CM PNEUMO INSUFF,90000065,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
CATH - 4FR PICC DUAL LUMEN,90000066,CDM,270,RC,,,outpatient,,,399,199.5,,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153.22,38.4,,122.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,153.22,38.4,,122.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,299.25,75,,239.4,percent of total billed charges,75% of total billed charges for outpatient setting,299.25,75,,239.4,percent of total billed charges,75% of total billed charges for outpatient setting,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,299.25,75,,239.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.65,35,,111.72,percent of total billed charges,35% of total billed charges for outpatient setting,311.22,78,,248.976,percent of total billed charges,78% of total billed charges for outpatient setting,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,279.3,70,,223.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.25,75,,239.4,percent of total billed charges,75% of total billed charges for outpatient setting,331.17,83,,264.936,percent of total billed charges,83% of total billed charges for outpatient setting,199.5,50,,159.6,percent of total billed charges,50% of total billed charges for outpatient setting,199.5,50,,159.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.28,39.17,,125.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,139.65,331.17,
INTRADUCER - 4MM PERITONEAL,90000067,CDM,270,RC,,,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,90.47,
KIT - TROCAR PROCEDURE,90000068,CDM,270,RC,,,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.6,96.28,
MASK - PED NRB,90000070,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
TUBE - SZ10 CANNULA TRACH DISP,90000071,CDM,270,RC,,,outpatient,,,164,82,,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,62.98,38.4,,50.384,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.4,35,,45.92,percent of total billed charges,35% of total billed charges for outpatient setting,127.92,78,,102.336,percent of total billed charges,78% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,114.8,70,,91.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123,75,,98.4,percent of total billed charges,75% of total billed charges for outpatient setting,136.12,83,,108.896,percent of total billed charges,83% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,82,50,,65.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.24,39.17,,51.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,57.4,136.12,
POWDER - 1 OZ OSTOMY,90000072,CDM,274,RC,A4371,HCPCS,both,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20,70,,16,percent of total billed charges,70% of total billed charges for outpatient setting,20,70,,16,percent of total billed charges,70% of total billed charges for outpatient setting,20,70,,16,percent of total billed charges,70% of total billed charges for outpatient setting,20,75,,16,percent of total billed charges,75% of total billed charges for outpatient setting,20,75,,16,percent of total billed charges,75% of total billed charges for outpatient setting,20,70,,16,percent of total billed charges,70% of total billed charges for outpatient setting,20,75,,16,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10,20,
DRESSING - OPTIFOAM 4X4 ADHESI,90000075,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
SET - UNIVERSAL ANESTHESIA,90000076,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
MASK - SZ 4 LMA DISP,90000078,CDM,270,RC,,,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42,99.6,
MASK - SZ 3 LMA DISP,90000079,CDM,270,RC,,,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42,99.6,
MASK - SZ 5 LMA DISP,90000080,CDM,270,RC,,,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.75,70.55,
MASK - SZ 2.5 LMA DISP,90000081,CDM,270,RC,,,outpatient,,,39,19.5,,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.98,38.4,,11.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.65,35,,10.92,percent of total billed charges,35% of total billed charges for outpatient setting,30.42,78,,24.336,percent of total billed charges,78% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,27.3,70,,21.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.25,75,,23.4,percent of total billed charges,75% of total billed charges for outpatient setting,32.37,83,,25.896,percent of total billed charges,83% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,19.5,50,,15.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.28,39.17,,12.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.65,32.37,
NEEDLE - 21GAX4 STIMUPLEX,90000083,CDM,270,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
NEEDLE - 22GAX2 STIMUPLEX TERMINATED,90000084,CDM,270,RC,,,outpatient,,,100,50,,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,38.4,38.4,,30.72,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35,35,,28,percent of total billed charges,35% of total billed charges for outpatient setting,78,78,,62.4,percent of total billed charges,78% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,70,70,,56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75,75,,60,percent of total billed charges,75% of total billed charges for outpatient setting,83,83,,66.4,percent of total billed charges,83% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,50,50,,40,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,39.17,,31.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35,83,
BLANKET - UB BAIR HUGGER,90000086,CDM,270,RC,,,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
MASK - SZ 2 UNIQUE LMA DISP,90000088,CDM,270,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
SUTURE - ETHILON 662G 4/0,90000089,CDM,270,RC,,,outpatient,,,65,32.5,,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.96,38.4,,19.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.75,35,,18.2,percent of total billed charges,35% of total billed charges for outpatient setting,50.7,78,,40.56,percent of total billed charges,78% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,45.5,70,,36.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.75,75,,39,percent of total billed charges,75% of total billed charges for outpatient setting,53.95,83,,43.16,percent of total billed charges,83% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,32.5,50,,26,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.46,39.17,,20.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,22.75,53.95,
SUTURE - 8425H PROLENE 1,90000090,CDM,270,RC,,,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
SUTURE - SILK C0125 2/0,90000091,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SUTURE - ETHILON 664H 2/0,90000093,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
SUTURE - ETHILON 1854G 4/0,90000094,CDM,270,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
SUTURE - ETHILON 1663G 3/0,90000096,CDM,270,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
TROCAR - SMALL JOINT ARTH,90000097,CDM,270,RC,,,outpatient,,,364,182,,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,139.78,38.4,,111.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,127.4,35,,101.92,percent of total billed charges,35% of total billed charges for outpatient setting,283.92,78,,227.136,percent of total billed charges,78% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,254.8,70,,203.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,273,75,,218.4,percent of total billed charges,75% of total billed charges for outpatient setting,302.12,83,,241.696,percent of total billed charges,83% of total billed charges for outpatient setting,182,50,,145.6,percent of total billed charges,50% of total billed charges for outpatient setting,182,50,,145.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.58,39.17,,114.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,127.4,302.12,
TROCAR - 5.8MM ARTHO KNEE,90000098,CDM,270,RC,,,outpatient,,,1670,835,,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,641.28,38.4,,513.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,641.28,38.4,,513.024,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,1252.5,75,,1002,percent of total billed charges,75% of total billed charges for outpatient setting,1252.5,75,,1002,percent of total billed charges,75% of total billed charges for outpatient setting,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,1252.5,75,,1002,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,584.5,35,,467.6,percent of total billed charges,35% of total billed charges for outpatient setting,1302.6,78,,1042.08,percent of total billed charges,78% of total billed charges for outpatient setting,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,1169,70,,935.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1252.5,75,,1002,percent of total billed charges,75% of total billed charges for outpatient setting,1386.1,83,,1108.88,percent of total billed charges,83% of total billed charges for outpatient setting,835,50,,668,percent of total billed charges,50% of total billed charges for outpatient setting,835,50,,668,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,654.11,39.17,,523.288,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,584.5,1386.1,
ENDO AVITENE 10MM,90000100,CDM,270,RC,,,outpatient,,,340,170,,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.56,38.4,,104.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,130.56,38.4,,104.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119,35,,95.2,percent of total billed charges,35% of total billed charges for outpatient setting,265.2,78,,212.16,percent of total billed charges,78% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,238,70,,190.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255,75,,204,percent of total billed charges,75% of total billed charges for outpatient setting,282.2,83,,225.76,percent of total billed charges,83% of total billed charges for outpatient setting,170,50,,136,percent of total billed charges,50% of total billed charges for outpatient setting,170,50,,136,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.17,39.17,,106.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,119,282.2,
AVITENE - .5 GRAM,90000102,CDM,270,RC,,,outpatient,,,215,107.5,,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.56,38.4,,66.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.25,35,,60.2,percent of total billed charges,35% of total billed charges for outpatient setting,167.7,78,,134.16,percent of total billed charges,78% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,150.5,70,,120.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.25,75,,129,percent of total billed charges,75% of total billed charges for outpatient setting,178.45,83,,142.76,percent of total billed charges,83% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,107.5,50,,86,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.21,39.17,,67.368,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,75.25,178.45,
SET - PEDS TRIPLE LUMEN CVS,90000103,CDM,270,RC,,,outpatient,,,222,111,,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,85.25,38.4,,68.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,85.25,38.4,,68.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.7,35,,62.16,percent of total billed charges,35% of total billed charges for outpatient setting,173.16,78,,138.528,percent of total billed charges,78% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,155.4,70,,124.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.5,75,,133.2,percent of total billed charges,75% of total billed charges for outpatient setting,184.26,83,,147.408,percent of total billed charges,83% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,111,50,,88.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.96,39.17,,69.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,77.7,184.26,
NEEDLE - ASPIRATION INJECTION,90000104,CDM,270,RC,,,outpatient,,,102,51,,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.17,38.4,,31.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.7,35,,28.56,percent of total billed charges,35% of total billed charges for outpatient setting,79.56,78,,63.648,percent of total billed charges,78% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,71.4,70,,57.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.5,75,,61.2,percent of total billed charges,75% of total billed charges for outpatient setting,84.66,83,,67.728,percent of total billed charges,83% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,51,50,,40.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.95,39.17,,31.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,35.7,84.66,
SPLINT - SM CLAVICLE SUPPORT,90000106,CDM,270,RC,L3650,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
SPLINT - MD CLAVICLE SUPPORT,90000107,CDM,270,RC,L3650,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
SPLINT - LG CLAVICLE SUPPORT,90000108,CDM,270,RC,L3650,HCPCS,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
SET - STANDARD FLOW WARMING RANGER,90000109,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
SPLINT - SM LT PD COLLES,90000110,CDM,270,RC,L3999,HCPCS,outpatient,,,40,20,,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.36,38.4,,12.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14,35,,11.2,percent of total billed charges,35% of total billed charges for outpatient setting,31.2,78,,24.96,percent of total billed charges,78% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30,75,,24,percent of total billed charges,75% of total billed charges for outpatient setting,33.2,83,,26.56,percent of total billed charges,83% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,20,50,,16,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.67,39.17,,12.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14,33.2,
SPLINT - SM RT PD COLLES,90000111,CDM,270,RC,L3999,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
SPLINT - XS RT PD COLLES,90000112,CDM,270,RC,L3999,HCPCS,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
INSTRUMENT - 8FR FRAZIER SUCTI,90000113,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
SUTURE - 3-0 VICRYL VCP332H,90000115,CDM,270,RC,,,outpatient,,,80,40,,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.72,38.4,,24.576,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28,35,,22.4,percent of total billed charges,35% of total billed charges for outpatient setting,62.4,78,,49.92,percent of total billed charges,78% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,56,70,,44.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60,75,,48,percent of total billed charges,75% of total billed charges for outpatient setting,66.4,83,,53.12,percent of total billed charges,83% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,40,50,,32,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.33,39.17,,25.064,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,28,66.4,
SUTURE - 2-0 PROLENE 8411H,90000116,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
STAPLER - TCT75 80-4.8,90000118,CDM,270,RC,,,outpatient,,,437,218.5,,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,167.81,38.4,,134.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,167.81,38.4,,134.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,327.75,75,,262.2,percent of total billed charges,75% of total billed charges for outpatient setting,327.75,75,,262.2,percent of total billed charges,75% of total billed charges for outpatient setting,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,327.75,75,,262.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.95,35,,122.36,percent of total billed charges,35% of total billed charges for outpatient setting,340.86,78,,272.688,percent of total billed charges,78% of total billed charges for outpatient setting,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,305.9,70,,244.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.75,75,,262.2,percent of total billed charges,75% of total billed charges for outpatient setting,362.71,83,,290.168,percent of total billed charges,83% of total billed charges for outpatient setting,218.5,50,,174.8,percent of total billed charges,50% of total billed charges for outpatient setting,218.5,50,,174.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,171.17,39.17,,136.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,152.95,362.71,
STAPLER - TX6OB 60MM PROXIMA,90000119,CDM,270,RC,,,outpatient,,,305,152.5,,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.12,38.4,,93.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,117.12,38.4,,93.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,228.75,75,,183,percent of total billed charges,75% of total billed charges for outpatient setting,228.75,75,,183,percent of total billed charges,75% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,228.75,75,,183,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.75,35,,85.4,percent of total billed charges,35% of total billed charges for outpatient setting,237.9,78,,190.32,percent of total billed charges,78% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,213.5,70,,170.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,228.75,75,,183,percent of total billed charges,75% of total billed charges for outpatient setting,253.15,83,,202.52,percent of total billed charges,83% of total billed charges for outpatient setting,152.5,50,,122,percent of total billed charges,50% of total billed charges for outpatient setting,152.5,50,,122,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.46,39.17,,95.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,106.75,253.15,
STAPLER - TX30B LINEAR,90000120,CDM,270,RC,,,outpatient,,,301,150.5,,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.58,38.4,,92.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,115.58,38.4,,92.464,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.35,35,,84.28,percent of total billed charges,35% of total billed charges for outpatient setting,234.78,78,,187.824,percent of total billed charges,78% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,210.7,70,,168.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,75,,180.6,percent of total billed charges,75% of total billed charges for outpatient setting,249.83,83,,199.864,percent of total billed charges,83% of total billed charges for outpatient setting,150.5,50,,120.4,percent of total billed charges,50% of total billed charges for outpatient setting,150.5,50,,120.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,117.89,39.17,,94.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,105.35,249.83,
REFILL - TCR75 80-3.8,90000121,CDM,270,RC,,,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.5,207.5,
REFILL - TX60B XR60B 60-3.5,90000122,CDM,270,RC,,,outpatient,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.5,157.7,
REFILL - XR30 B,90000123,CDM,270,RC,,,outpatient,,,176,88,,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.6,35,,49.28,percent of total billed charges,35% of total billed charges for outpatient setting,137.28,78,,109.824,percent of total billed charges,78% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.08,83,,116.864,percent of total billed charges,83% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.93,39.17,,55.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,61.6,146.08,
REFILL - TRT75 80-4.8,90000124,CDM,270,RC,,,outpatient,,,271,135.5,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.85,35,,75.88,percent of total billed charges,35% of total billed charges for outpatient setting,211.38,78,,169.104,percent of total billed charges,78% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,224.93,83,,179.944,percent of total billed charges,83% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.14,39.17,,84.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,94.85,224.93,
LIGACLIP - MD APPLIER,90000125,CDM,270,RC,,,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,35,,67.2,percent of total billed charges,35% of total billed charges for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94,39.17,,75.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84,199.2,
RESERVOIR - 1305 JP BULB,90000126,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
SUTURE - VCP603H,90000127,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
LENS - MORGAN MEDIFLOW,90000128,CDM,270,RC,,,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42,99.6,
SNARE - SD-230U-20 SPRIAL,90000129,CDM,270,RC,,,outpatient,,,103,51.5,,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.55,38.4,,31.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.05,35,,28.84,percent of total billed charges,35% of total billed charges for outpatient setting,80.34,78,,64.272,percent of total billed charges,78% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,72.1,70,,57.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.25,75,,61.8,percent of total billed charges,75% of total billed charges for outpatient setting,85.49,83,,68.392,percent of total billed charges,83% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,51.5,50,,41.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.34,39.17,,32.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.05,85.49,
RELOAD - 45MM LINEAR CUTTER VA,90000130,CDM,270,RC,,,outpatient,,,483,241.5,,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,185.47,38.4,,148.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.05,35,,135.24,percent of total billed charges,35% of total billed charges for outpatient setting,376.74,78,,301.392,percent of total billed charges,78% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,338.1,70,,270.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,362.25,75,,289.8,percent of total billed charges,75% of total billed charges for outpatient setting,400.89,83,,320.712,percent of total billed charges,83% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,241.5,50,,193.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,189.18,39.17,,151.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,169.05,400.89,
RELOAD - 45MM LINEAR CUTTER RE,90000131,CDM,270,RC,,,outpatient,,,414,207,,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,158.98,38.4,,127.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,158.98,38.4,,127.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,310.5,75,,248.4,percent of total billed charges,75% of total billed charges for outpatient setting,310.5,75,,248.4,percent of total billed charges,75% of total billed charges for outpatient setting,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,310.5,75,,248.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.9,35,,115.92,percent of total billed charges,35% of total billed charges for outpatient setting,322.92,78,,258.336,percent of total billed charges,78% of total billed charges for outpatient setting,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,289.8,70,,231.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,310.5,75,,248.4,percent of total billed charges,75% of total billed charges for outpatient setting,343.62,83,,274.896,percent of total billed charges,83% of total billed charges for outpatient setting,207,50,,165.6,percent of total billed charges,50% of total billed charges for outpatient setting,207,50,,165.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.16,39.17,,129.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,144.9,343.62,
KIT - FEMORAL ARTERIAL LINECAT,90000132,CDM,270,RC,,,outpatient,,,117,58.5,,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.93,38.4,,35.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.93,38.4,,35.944,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.95,35,,32.76,percent of total billed charges,35% of total billed charges for outpatient setting,91.26,78,,73.008,percent of total billed charges,78% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,81.9,70,,65.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.75,75,,70.2,percent of total billed charges,75% of total billed charges for outpatient setting,97.11,83,,77.688,percent of total billed charges,83% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,58.5,50,,46.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.83,39.17,,36.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.95,97.11,
DRAIN - CATH 8.5FR PIGTAIL,90000133,CDM,270,RC,,,outpatient,,,407,203.5,,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.29,38.4,,125.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.29,38.4,,125.032,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.45,35,,113.96,percent of total billed charges,35% of total billed charges for outpatient setting,317.46,78,,253.968,percent of total billed charges,78% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,284.9,70,,227.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,305.25,75,,244.2,percent of total billed charges,75% of total billed charges for outpatient setting,337.81,83,,270.248,percent of total billed charges,83% of total billed charges for outpatient setting,203.5,50,,162.8,percent of total billed charges,50% of total billed charges for outpatient setting,203.5,50,,162.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.42,39.17,,127.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,142.45,337.81,
POWDER - SILVER DRESSING,90000138,CDM,270,RC,,,outpatient,,,66,33,,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.34,38.4,,20.272,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.1,35,,18.48,percent of total billed charges,35% of total billed charges for outpatient setting,51.48,78,,41.184,percent of total billed charges,78% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,46.2,70,,36.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49.5,75,,39.6,percent of total billed charges,75% of total billed charges for outpatient setting,54.78,83,,43.824,percent of total billed charges,83% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,33,50,,26.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.85,39.17,,20.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,23.1,54.78,
KIT - PERCUT SHEATH INTRODUCER,90000140,CDM,270,RC,,,outpatient,,,121,60.5,,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.46,38.4,,37.168,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.35,35,,33.88,percent of total billed charges,35% of total billed charges for outpatient setting,94.38,78,,75.504,percent of total billed charges,78% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,84.7,70,,67.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90.75,75,,72.6,percent of total billed charges,75% of total billed charges for outpatient setting,100.43,83,,80.344,percent of total billed charges,83% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,60.5,50,,48.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47.39,39.17,,37.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42.35,100.43,
FLOAT - HEEL MED SKIL CARE,90000141,CDM,270,RC,,,outpatient,,,176,88,,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,67.58,38.4,,54.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,61.6,35,,49.28,percent of total billed charges,35% of total billed charges for outpatient setting,137.28,78,,109.824,percent of total billed charges,78% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,123.2,70,,98.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132,75,,105.6,percent of total billed charges,75% of total billed charges for outpatient setting,146.08,83,,116.864,percent of total billed charges,83% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,88,50,,70.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.93,39.17,,55.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,61.6,146.08,
FLOAT - HEEL LRG SKIL CARE,90000142,CDM,270,RC,,,outpatient,,,201,100.5,,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,77.18,38.4,,61.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.35,35,,56.28,percent of total billed charges,35% of total billed charges for outpatient setting,156.78,78,,125.424,percent of total billed charges,78% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,140.7,70,,112.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.75,75,,120.6,percent of total billed charges,75% of total billed charges for outpatient setting,166.83,83,,133.464,percent of total billed charges,83% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,100.5,50,,80.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.72,39.17,,62.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,70.35,166.83,
SYSTEM - NEBU-MASK ADULT,90000143,CDM,270,RC,,,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
TRAY - 5FR PED URINE METER CAT,90000144,CDM,270,RC,,,outpatient,,,56,28,,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.5,38.4,,17.2,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.6,35,,15.68,percent of total billed charges,35% of total billed charges for outpatient setting,43.68,78,,34.944,percent of total billed charges,78% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,39.2,70,,31.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,75,,33.6,percent of total billed charges,75% of total billed charges for outpatient setting,46.48,83,,37.184,percent of total billed charges,83% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,28,50,,22.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.93,39.17,,17.544,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.6,46.48,
BLADE - #3 MAC DISP,90000145,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
BLADE - #4 MAC DISP EQUIPLITE LARYNG,90000146,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
BLADE - #1 MACINTOSH DISP,90000147,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
BLADE - #2 MAC DISP,90000148,CDM,270,RC,,,outpatient,,,29,14.5,,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.14,38.4,,8.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.15,35,,8.12,percent of total billed charges,35% of total billed charges for outpatient setting,22.62,78,,18.096,percent of total billed charges,78% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,20.3,70,,16.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.75,75,,17.4,percent of total billed charges,75% of total billed charges for outpatient setting,24.07,83,,19.256,percent of total billed charges,83% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,14.5,50,,11.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.36,39.17,,9.088,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.15,24.07,
BLADE - #0 MILLER DISP RUSH POLARIS,90000149,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
BLADE - #1 MILLER DISP EQUIPLITE RUSCH,90000150,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
BLADE - #2 MILLER DISP RUSCH POLARIS,90000151,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
PROBE - 14GAX105MM BIOPSY ULTR,90000153,CDM,270,RC,,,outpatient,,,955,477.5,,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,366.72,38.4,,293.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,366.72,38.4,,293.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,716.25,75,,573,percent of total billed charges,75% of total billed charges for outpatient setting,716.25,75,,573,percent of total billed charges,75% of total billed charges for outpatient setting,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,716.25,75,,573,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,334.25,35,,267.4,percent of total billed charges,35% of total billed charges for outpatient setting,744.9,78,,595.92,percent of total billed charges,78% of total billed charges for outpatient setting,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,668.5,70,,534.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,716.25,75,,573,percent of total billed charges,75% of total billed charges for outpatient setting,792.65,83,,634.12,percent of total billed charges,83% of total billed charges for outpatient setting,477.5,50,,382,percent of total billed charges,50% of total billed charges for outpatient setting,477.5,50,,382,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,374.05,39.17,,299.24,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,334.25,792.65,
PROBE - 10GAX105MM BIOPSY ULTR,90000154,CDM,270,RC,,,outpatient,,,887,443.5,,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,340.61,38.4,,272.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,340.61,38.4,,272.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,665.25,75,,532.2,percent of total billed charges,75% of total billed charges for outpatient setting,665.25,75,,532.2,percent of total billed charges,75% of total billed charges for outpatient setting,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,665.25,75,,532.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,310.45,35,,248.36,percent of total billed charges,35% of total billed charges for outpatient setting,691.86,78,,553.488,percent of total billed charges,78% of total billed charges for outpatient setting,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,620.9,70,,496.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,665.25,75,,532.2,percent of total billed charges,75% of total billed charges for outpatient setting,736.21,83,,588.968,percent of total billed charges,83% of total billed charges for outpatient setting,443.5,50,,354.8,percent of total billed charges,50% of total billed charges for outpatient setting,443.5,50,,354.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,347.42,39.17,,277.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,310.45,736.21,
MARKER - WING BREAST DUAL TRIG,90000155,CDM,270,RC,,,outpatient,,,190,95,,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,72.96,38.4,,58.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,66.5,35,,53.2,percent of total billed charges,35% of total billed charges for outpatient setting,148.2,78,,118.56,percent of total billed charges,78% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,133,70,,106.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.5,75,,114,percent of total billed charges,75% of total billed charges for outpatient setting,157.7,83,,126.16,percent of total billed charges,83% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,95,50,,76,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,74.42,39.17,,59.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,66.5,157.7,
MARKER - RIBBON BREAST DUAL TR,90000156,CDM,270,RC,,,outpatient,,,271,135.5,,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,104.06,38.4,,83.248,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94.85,35,,75.88,percent of total billed charges,35% of total billed charges for outpatient setting,211.38,78,,169.104,percent of total billed charges,78% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,189.7,70,,151.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,203.25,75,,162.6,percent of total billed charges,75% of total billed charges for outpatient setting,224.93,83,,179.944,percent of total billed charges,83% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,135.5,50,,108.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,106.14,39.17,,84.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,94.85,224.93,
MARKER - COIL BREAST DUAL TRIG,90000157,CDM,270,RC,,,outpatient,,,379,189.5,,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.54,38.4,,116.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,145.54,38.4,,116.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.65,35,,106.12,percent of total billed charges,35% of total billed charges for outpatient setting,295.62,78,,236.496,percent of total billed charges,78% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.3,70,,212.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,284.25,75,,227.4,percent of total billed charges,75% of total billed charges for outpatient setting,314.57,83,,251.656,percent of total billed charges,83% of total billed charges for outpatient setting,189.5,50,,151.6,percent of total billed charges,50% of total billed charges for outpatient setting,189.5,50,,151.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.45,39.17,,118.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,132.65,314.57,
STRIP - .5X5YD IODOFORM PACKI,90000160,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
SNARE - SK-210U-25 SOFT OVAL,90000161,CDM,270,RC,,,outpatient,,,84,42,,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.26,38.4,,25.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.4,35,,23.52,percent of total billed charges,35% of total billed charges for outpatient setting,65.52,78,,52.416,percent of total billed charges,78% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,58.8,70,,47.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,75,,50.4,percent of total billed charges,75% of total billed charges for outpatient setting,69.72,83,,55.776,percent of total billed charges,83% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,42,50,,33.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.91,39.17,,26.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.4,69.72,
FORCEP - 5MM 33 CM BABCOCK GRA,90000162,CDM,270,RC,,,outpatient,,,1328,664,,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,509.95,38.4,,407.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,509.95,38.4,,407.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,464.8,35,,371.84,percent of total billed charges,35% of total billed charges for outpatient setting,1035.84,78,,828.672,percent of total billed charges,78% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,929.6,70,,743.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,996,75,,796.8,percent of total billed charges,75% of total billed charges for outpatient setting,1102.24,83,,881.792,percent of total billed charges,83% of total billed charges for outpatient setting,664,50,,531.2,percent of total billed charges,50% of total billed charges for outpatient setting,664,50,,531.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,520.15,39.17,,416.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,464.8,1102.24,
SUTURE - ETHILON 1698G 6/0,90000163,CDM,270,RC,,,outpatient,,,19,9.5,,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.3,38.4,,5.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.65,35,,5.32,percent of total billed charges,35% of total billed charges for outpatient setting,14.82,78,,11.856,percent of total billed charges,78% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,13.3,70,,10.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.25,75,,11.4,percent of total billed charges,75% of total billed charges for outpatient setting,15.77,83,,12.616,percent of total billed charges,83% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,9.5,50,,7.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.45,39.17,,5.96,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.65,15.77,
BLADE - CTB73 KII 12X100 SHOU-,90000168,CDM,270,RC,,,outpatient,,,125,62.5,,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,48,38.4,,38.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.75,35,,35,percent of total billed charges,35% of total billed charges for outpatient setting,97.5,78,,78,percent of total billed charges,78% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,87.5,70,,70,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.75,75,,75,percent of total billed charges,75% of total billed charges for outpatient setting,103.75,83,,83,percent of total billed charges,83% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,62.5,50,,50,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,48.96,39.17,,39.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,43.75,103.75,
TROCAR - CTB03 BLD 5X100MMU HN,90000170,CDM,270,RC,,,outpatient,,,109,54.5,,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.86,38.4,,33.488,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.15,35,,30.52,percent of total billed charges,35% of total billed charges for outpatient setting,85.02,78,,68.016,percent of total billed charges,78% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,76.3,70,,61.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.75,75,,65.4,percent of total billed charges,75% of total billed charges for outpatient setting,90.47,83,,72.376,percent of total billed charges,83% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,54.5,50,,43.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.7,39.17,,34.16,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,38.15,90.47,
KIT - 16FR BALLOON SLG,90000171,CDM,270,RC,,,outpatient,,,312,156,,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,119.81,38.4,,95.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,119.81,38.4,,95.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,109.2,35,,87.36,percent of total billed charges,35% of total billed charges for outpatient setting,243.36,78,,194.688,percent of total billed charges,78% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,218.4,70,,174.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,234,75,,187.2,percent of total billed charges,75% of total billed charges for outpatient setting,258.96,83,,207.168,percent of total billed charges,83% of total billed charges for outpatient setting,156,50,,124.8,percent of total billed charges,50% of total billed charges for outpatient setting,156,50,,124.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.21,39.17,,97.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,109.2,258.96,
POUCH - CONVEX OSTOMY,90000172,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
WAFER - CONVEX OSTOMY,90000173,CDM,270,RC,,,outpatient,,,95,47.5,,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.25,35,,26.6,percent of total billed charges,35% of total billed charges for outpatient setting,74.1,78,,59.28,percent of total billed charges,78% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,78.85,83,,63.08,percent of total billed charges,83% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.21,39.17,,29.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.25,78.85,
GAUZE-HONEY THERAPY 4X5,90000175,CDM,270,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
HOLDER - FITS ALL TRACH TUBE,90000176,CDM,270,RC,A7526,HCPCS,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.5,14.11,
CANNULA - 6.0 XLT INNER DISP,90000181,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
PLUG - DECANNULATION INNER CNL,90000182,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TUBE - 10.0 MM ET CUFFED,90000183,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
TUBE - 5.5 MM ET CUFFED,90000184,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
TUBE - 9.0 MM ET CUFFED,90000185,CDM,270,RC,,,outpatient,,,11,5.5,,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.22,38.4,,3.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.85,35,,3.08,percent of total billed charges,35% of total billed charges for outpatient setting,8.58,78,,6.864,percent of total billed charges,78% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,7.7,70,,6.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.25,75,,6.6,percent of total billed charges,75% of total billed charges for outpatient setting,9.13,83,,7.304,percent of total billed charges,83% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,5.5,50,,4.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.3,39.17,,3.44,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.85,9.13,
SPONGE - PEANUT 3/8,90000187,CDM,270,RC,,,outpatient,,,6,3,,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.3,38.4,,1.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.1,35,,1.68,percent of total billed charges,35% of total billed charges for outpatient setting,4.68,78,,3.744,percent of total billed charges,78% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,4.2,70,,3.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.5,75,,3.6,percent of total billed charges,75% of total billed charges for outpatient setting,4.98,83,,3.984,percent of total billed charges,83% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,3,50,,2.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.35,39.17,,1.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.1,4.98,
KIT - 18FR 2.0 MIC-KEY LOW PRO,90000188,CDM,270,RC,,,outpatient,,,328,164,,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.95,38.4,,100.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.8,35,,91.84,percent of total billed charges,35% of total billed charges for outpatient setting,255.84,78,,204.672,percent of total billed charges,78% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,229.6,70,,183.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246,75,,196.8,percent of total billed charges,75% of total billed charges for outpatient setting,272.24,83,,217.792,percent of total billed charges,83% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,164,50,,131.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.47,39.17,,102.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.8,272.24,
FILTER - BACTERIA MAINFLOW,90000189,CDM,270,RC,,,outpatient,,,274,137,,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105.22,38.4,,84.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,95.9,35,,76.72,percent of total billed charges,35% of total billed charges for outpatient setting,213.72,78,,170.976,percent of total billed charges,78% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,191.8,70,,153.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.5,75,,164.4,percent of total billed charges,75% of total billed charges for outpatient setting,227.42,83,,181.936,percent of total billed charges,83% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,137,50,,109.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,107.32,39.17,,85.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,95.9,227.42,
MASK - PED AEROSOL,90000190,CDM,270,RC,,,outpatient,,,5,2.5,,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.92,38.4,,1.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.75,35,,1.4,percent of total billed charges,35% of total billed charges for outpatient setting,3.9,78,,3.12,percent of total billed charges,78% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,3.5,70,,2.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.75,75,,3,percent of total billed charges,75% of total billed charges for outpatient setting,4.15,83,,3.32,percent of total billed charges,83% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,2.5,50,,2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.96,39.17,,1.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.75,4.15,
SET - CONTINUOUS FEED,90000194,CDM,270,RC,,,outpatient,,,34,17,,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.06,38.4,,10.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,35,,9.52,percent of total billed charges,35% of total billed charges for outpatient setting,26.52,78,,21.216,percent of total billed charges,78% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,23.8,70,,19.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.5,75,,20.4,percent of total billed charges,75% of total billed charges for outpatient setting,28.22,83,,22.576,percent of total billed charges,83% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,17,50,,13.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.32,39.17,,10.656,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.9,28.22,
DRAIN - 19FR FULL FLUTED,90000201,CDM,270,RC,,,outpatient,,,51,25.5,,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.58,38.4,,15.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.85,35,,14.28,percent of total billed charges,35% of total billed charges for outpatient setting,39.78,78,,31.824,percent of total billed charges,78% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,35.7,70,,28.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.25,75,,30.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.33,83,,33.864,percent of total billed charges,83% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,25.5,50,,20.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,39.17,,15.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.85,42.33,
DEVICE - 18GA COAXIAL BIOPSY,90000202,CDM,270,RC,,,outpatient,,,181,90.5,,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.5,38.4,,55.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.5,38.4,,55.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.35,35,,50.68,percent of total billed charges,35% of total billed charges for outpatient setting,141.18,78,,112.944,percent of total billed charges,78% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,126.7,70,,101.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.75,75,,108.6,percent of total billed charges,75% of total billed charges for outpatient setting,150.23,83,,120.184,percent of total billed charges,83% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,90.5,50,,72.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.89,39.17,,56.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63.35,150.23,
CATH - 7FR GROSHONG SINGLE,90000204,CDM,270,RC,,,outpatient,,,971,485.5,,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,372.86,38.4,,298.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,372.86,38.4,,298.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,728.25,75,,582.6,percent of total billed charges,75% of total billed charges for outpatient setting,728.25,75,,582.6,percent of total billed charges,75% of total billed charges for outpatient setting,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,728.25,75,,582.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.85,35,,271.88,percent of total billed charges,35% of total billed charges for outpatient setting,757.38,78,,605.904,percent of total billed charges,78% of total billed charges for outpatient setting,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,679.7,70,,543.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,728.25,75,,582.6,percent of total billed charges,75% of total billed charges for outpatient setting,805.93,83,,644.744,percent of total billed charges,83% of total billed charges for outpatient setting,485.5,50,,388.4,percent of total billed charges,50% of total billed charges for outpatient setting,485.5,50,,388.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,380.32,39.17,,304.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,339.85,805.93,
CUFF - #2 BP NEONATAL,90000205,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
KIT - 6FR SUCTION CATH,90000206,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
CLIP - HEMOSTATS UPPER,90000207,CDM,270,RC,,,outpatient,,,293,146.5,,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.51,38.4,,90.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,112.51,38.4,,90.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.55,35,,82.04,percent of total billed charges,35% of total billed charges for outpatient setting,228.54,78,,182.832,percent of total billed charges,78% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,205.1,70,,164.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,219.75,75,,175.8,percent of total billed charges,75% of total billed charges for outpatient setting,243.19,83,,194.552,percent of total billed charges,83% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,146.5,50,,117.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.76,39.17,,91.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,102.55,243.19,
CLIP - HEMOSTATS LOWER,90000208,CDM,270,RC,,,outpatient,,,685,342.5,,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.04,38.4,,210.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,263.04,38.4,,210.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,239.75,35,,191.8,percent of total billed charges,35% of total billed charges for outpatient setting,534.3,78,,427.44,percent of total billed charges,78% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,479.5,70,,383.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,513.75,75,,411,percent of total billed charges,75% of total billed charges for outpatient setting,568.55,83,,454.84,percent of total billed charges,83% of total billed charges for outpatient setting,342.5,50,,274,percent of total billed charges,50% of total billed charges for outpatient setting,342.5,50,,274,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,268.3,39.17,,214.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,239.75,568.55,
TUBING - CORRUGATED,90000210,CDM,270,RC,,,outpatient,,,75,37.5,,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.8,38.4,,23.04,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,35,,21,percent of total billed charges,35% of total billed charges for outpatient setting,58.5,78,,46.8,percent of total billed charges,78% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,52.5,70,,42,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,56.25,75,,45,percent of total billed charges,75% of total billed charges for outpatient setting,62.25,83,,49.8,percent of total billed charges,83% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,37.5,50,,30,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.38,39.17,,23.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.25,62.25,
DRESSING - PED 1.75X1.75 TEGAD,90000211,CDM,270,RC,,,outpatient,,,3,1.5,,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.15,38.4,,0.92,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.05,35,,0.84,percent of total billed charges,35% of total billed charges for outpatient setting,2.34,78,,1.872,percent of total billed charges,78% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,2.1,70,,1.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.25,75,,1.8,percent of total billed charges,75% of total billed charges for outpatient setting,2.49,83,,1.992,percent of total billed charges,83% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,1.5,50,,1.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.17,39.17,,0.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.05,2.49,
PACK - PRECIP DISP,90000212,CDM,270,RC,,,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,81.34,
SKIN GRAFT - 1 TO 1.5 EXPANSIO,90000213,CDM,270,RC,,,outpatient,,,98,49,,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.63,38.4,,30.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.3,35,,27.44,percent of total billed charges,35% of total billed charges for outpatient setting,76.44,78,,61.152,percent of total billed charges,78% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,68.6,70,,54.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,75,,58.8,percent of total billed charges,75% of total billed charges for outpatient setting,81.34,83,,65.072,percent of total billed charges,83% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,49,50,,39.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,38.38,39.17,,30.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,34.3,81.34,
DRAIN - 1311 10MM JP,90000214,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TUBE - 8.0MM XLENGTH TRACH,90000215,CDM,270,RC,,,outpatient,,,421,210.5,,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.35,35,,117.88,percent of total billed charges,35% of total billed charges for outpatient setting,328.38,78,,262.704,percent of total billed charges,78% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,349.43,83,,279.544,percent of total billed charges,83% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.89,39.17,,131.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147.35,349.43,
ADHESIVE - MASTISOL LIQUID,90000217,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
MESH - CQUR 5X5 ATRIUM,90000218,CDM,278,RC,,,both,,,978,489,,684.6,70,,547.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.55,38.4,,300.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,375.55,38.4,,300.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,684.6,70,,547.68,percent of total billed charges,70% of billed charges for implant carveouts,684.6,70,,547.68,percent of total billed charges,70% of billed charges for implant carveouts,684.6,70,,547.68,percent of total billed charges,70% of billed charges for implant carveouts,782.4,80,,625.92,percent of total billed charges,80% of billed charges for implant carveouts,782.4,80,,625.92,percent of total billed charges,80% of billed charges for implant carveouts,684.6,70,,547.68,percent of total billed charges,70% of billed charges for implant carveouts,782.4,80,,625.92,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,342.3,35,,273.84,percent of total billed charges,35% of total billed charges for outpatient setting,762.84,78,,610.272,percent of total billed charges,78% of total billed charges for outpatient setting,684.6,70,,547.68,percent of total billed charges,70% of total billed charges for outpatient setting,684.6,70,,547.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,733.5,75,,586.8,percent of total billed charges,75% of total billed charges for outpatient setting,811.74,83,,649.392,percent of total billed charges,83% of total billed charges for outpatient setting,489,50,,391.2,percent of total billed charges,50% of total billed charges for outpatient setting,489,50,,391.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,383.06,39.17,,306.448,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,342.3,811.74,
MESH - CQUR 6X8 ATRIUM,90000219,CDM,278,RC,C1781,HCPCS,both,,,1969,984.5,,1378.3,70,,1102.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,756.1,38.4,,604.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,756.1,38.4,,604.88,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1378.3,70,,1102.64,percent of total billed charges,70% of billed charges for implant carveouts,1378.3,70,,1102.64,percent of total billed charges,70% of billed charges for implant carveouts,1378.3,70,,1102.64,percent of total billed charges,70% of billed charges for implant carveouts,1575.2,80,,1260.16,percent of total billed charges,80% of billed charges for implant carveouts,1575.2,80,,1260.16,percent of total billed charges,80% of billed charges for implant carveouts,1378.3,70,,1102.64,percent of total billed charges,70% of billed charges for implant carveouts,1575.2,80,,1260.16,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,689.15,35,,551.32,percent of total billed charges,35% of total billed charges for outpatient setting,1535.82,78,,1228.656,percent of total billed charges,78% of total billed charges for outpatient setting,1378.3,70,,1102.64,percent of total billed charges,70% of total billed charges for outpatient setting,1378.3,70,,1102.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1476.75,75,,1181.4,percent of total billed charges,75% of total billed charges for outpatient setting,1634.27,83,,1307.416,percent of total billed charges,83% of total billed charges for outpatient setting,984.5,50,,787.6,percent of total billed charges,50% of total billed charges for outpatient setting,984.5,50,,787.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,771.22,39.17,,616.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,689.15,1634.27,
MESH - LT PARIETEX 6X8,90000220,CDM,278,RC,C1781,HCPCS,both,,,391.26,195.63,,273.88,70,,219.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.24,38.4,,120.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.24,38.4,,120.192,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,391.26,70,,313.008,percent of total billed charges,70% of total billed charges for outpatient setting,391.26,70,,313.008,percent of total billed charges,70% of total billed charges for outpatient setting,391.26,70,,313.008,percent of total billed charges,70% of total billed charges for outpatient setting,391.26,75,,313.008,percent of total billed charges,75% of total billed charges for outpatient setting,391.26,75,,313.008,percent of total billed charges,75% of total billed charges for outpatient setting,391.26,70,,313.008,percent of total billed charges,70% of total billed charges for outpatient setting,391.26,75,,313.008,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.94,35,,109.552,percent of total billed charges,35% of total billed charges for outpatient setting,305.18,78,,244.144,percent of total billed charges,78% of total billed charges for outpatient setting,273.88,70,,219.104,percent of total billed charges,70% of total billed charges for outpatient setting,273.88,70,,219.104,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.45,75,,234.76,percent of total billed charges,75% of total billed charges for outpatient setting,324.75,83,,259.8,percent of total billed charges,83% of total billed charges for outpatient setting,195.63,50,,156.504,percent of total billed charges,50% of total billed charges for outpatient setting,195.63,50,,156.504,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,153.24,39.17,,122.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.94,391.26,
MESH - RT PARIETEX 6X4,90000221,CDM,278,RC,C1781,HCPCS,both,,,445.11,222.56,,311.58,70,,249.264,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,170.92,38.4,,136.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,170.92,38.4,,136.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445.11,70,,356.088,percent of total billed charges,70% of total billed charges for outpatient setting,445.11,70,,356.088,percent of total billed charges,70% of total billed charges for outpatient setting,445.11,70,,356.088,percent of total billed charges,70% of total billed charges for outpatient setting,445.11,75,,356.088,percent of total billed charges,75% of total billed charges for outpatient setting,445.11,75,,356.088,percent of total billed charges,75% of total billed charges for outpatient setting,445.11,70,,356.088,percent of total billed charges,70% of total billed charges for outpatient setting,445.11,75,,356.088,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.79,35,,124.632,percent of total billed charges,35% of total billed charges for outpatient setting,347.19,78,,277.752,percent of total billed charges,78% of total billed charges for outpatient setting,311.58,70,,249.264,percent of total billed charges,70% of total billed charges for outpatient setting,311.58,70,,249.264,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.83,75,,267.064,percent of total billed charges,75% of total billed charges for outpatient setting,369.44,83,,295.552,percent of total billed charges,83% of total billed charges for outpatient setting,222.56,50,,178.048,percent of total billed charges,50% of total billed charges for outpatient setting,222.56,50,,178.048,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,174.34,39.17,,139.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,155.79,445.11,
MESH - PARIETEX COMPOSITE 6,90000222,CDM,278,RC,C1781,HCPCS,both,,,1908,954,,1335.6,70,,1068.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,732.67,38.4,,586.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,732.67,38.4,,586.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1335.6,70,,1068.48,percent of total billed charges,70% of billed charges for implant carveouts,1335.6,70,,1068.48,percent of total billed charges,70% of billed charges for implant carveouts,1335.6,70,,1068.48,percent of total billed charges,70% of billed charges for implant carveouts,1526.4,80,,1221.12,percent of total billed charges,80% of billed charges for implant carveouts,1526.4,80,,1221.12,percent of total billed charges,80% of billed charges for implant carveouts,1335.6,70,,1068.48,percent of total billed charges,70% of billed charges for implant carveouts,1526.4,80,,1221.12,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,667.8,35,,534.24,percent of total billed charges,35% of total billed charges for outpatient setting,1488.24,78,,1190.592,percent of total billed charges,78% of total billed charges for outpatient setting,1335.6,70,,1068.48,percent of total billed charges,70% of total billed charges for outpatient setting,1335.6,70,,1068.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1431,75,,1144.8,percent of total billed charges,75% of total billed charges for outpatient setting,1583.64,83,,1266.912,percent of total billed charges,83% of total billed charges for outpatient setting,954,50,,763.2,percent of total billed charges,50% of total billed charges for outpatient setting,954,50,,763.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,747.32,39.17,,597.856,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,667.8,1583.64,
MESH - PROLENE PMII 3X6,90000223,CDM,278,RC,C1781,HCPCS,both,,,195.5,97.75,,136.85,70,,109.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.07,38.4,,60.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.07,38.4,,60.056,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,195.5,70,,156.4,percent of total billed charges,70% of total billed charges for outpatient setting,195.5,70,,156.4,percent of total billed charges,70% of total billed charges for outpatient setting,195.5,70,,156.4,percent of total billed charges,70% of total billed charges for outpatient setting,195.5,75,,156.4,percent of total billed charges,75% of total billed charges for outpatient setting,195.5,75,,156.4,percent of total billed charges,75% of total billed charges for outpatient setting,195.5,70,,156.4,percent of total billed charges,70% of total billed charges for outpatient setting,195.5,75,,156.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.43,35,,54.744,percent of total billed charges,35% of total billed charges for outpatient setting,152.49,78,,121.992,percent of total billed charges,78% of total billed charges for outpatient setting,136.85,70,,109.48,percent of total billed charges,70% of total billed charges for outpatient setting,136.85,70,,109.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,146.63,75,,117.304,percent of total billed charges,75% of total billed charges for outpatient setting,162.27,83,,129.816,percent of total billed charges,83% of total billed charges for outpatient setting,97.75,50,,78.2,percent of total billed charges,50% of total billed charges for outpatient setting,97.75,50,,78.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.57,39.17,,61.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.43,195.5,
KIT - STOMA CONE IRRIGATION,90000229,CDM,270,RC,,,outpatient,,,54,27,,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.74,38.4,,16.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.9,35,,15.12,percent of total billed charges,35% of total billed charges for outpatient setting,42.12,78,,33.696,percent of total billed charges,78% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,37.8,70,,30.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.5,75,,32.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.82,83,,35.856,percent of total billed charges,83% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,27,50,,21.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.15,39.17,,16.92,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.9,44.82,
COVER - RED SURGI-PAW 1/10,90000230,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
COVER - WHITE SURGI-PAW 2/10,90000231,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
CUBE - CARE 12X12X12,90000233,CDM,270,RC,,,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.3,48.14,
BALLOON - HERNIA DIX EX VIEW,90000234,CDM,270,RC,,,outpatient,,,1366,683,,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,524.54,38.4,,419.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,524.54,38.4,,419.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges for outpatient setting,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges for outpatient setting,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,478.1,35,,382.48,percent of total billed charges,35% of total billed charges for outpatient setting,1065.48,78,,852.384,percent of total billed charges,78% of total billed charges for outpatient setting,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,956.2,70,,764.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1024.5,75,,819.6,percent of total billed charges,75% of total billed charges for outpatient setting,1133.78,83,,907.024,percent of total billed charges,83% of total billed charges for outpatient setting,683,50,,546.4,percent of total billed charges,50% of total billed charges for outpatient setting,683,50,,546.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,535.03,39.17,,428.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,478.1,1133.78,
CATH - 3FR-80CM EMBOLECTOMY LF,90000235,CDM,270,RC,,,outpatient,,,390,195,,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,149.76,38.4,,119.808,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.5,35,,109.2,percent of total billed charges,35% of total billed charges for outpatient setting,304.2,78,,243.36,percent of total billed charges,78% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,273,70,,218.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.5,75,,234,percent of total billed charges,75% of total billed charges for outpatient setting,323.7,83,,258.96,percent of total billed charges,83% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,195,50,,156,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,152.76,39.17,,122.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,136.5,323.7,
NET - 3CM X 6 CM POLYP ROTH,90000240,CDM,270,RC,,,outpatient,,,408,204,,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,156.67,38.4,,125.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,156.67,38.4,,125.336,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.8,35,,114.24,percent of total billed charges,35% of total billed charges for outpatient setting,318.24,78,,254.592,percent of total billed charges,78% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,285.6,70,,228.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,306,75,,244.8,percent of total billed charges,75% of total billed charges for outpatient setting,338.64,83,,270.912,percent of total billed charges,83% of total billed charges for outpatient setting,204,50,,163.2,percent of total billed charges,50% of total billed charges for outpatient setting,204,50,,163.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,159.8,39.17,,127.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,142.8,338.64,
NET - 4CMX5.5CM BOLUS ROTH,90000241,CDM,270,RC,,,outpatient,,,343,171.5,,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,131.71,38.4,,105.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,131.71,38.4,,105.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.25,75,,205.8,percent of total billed charges,75% of total billed charges for outpatient setting,257.25,75,,205.8,percent of total billed charges,75% of total billed charges for outpatient setting,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,257.25,75,,205.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.05,35,,96.04,percent of total billed charges,35% of total billed charges for outpatient setting,267.54,78,,214.032,percent of total billed charges,78% of total billed charges for outpatient setting,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,240.1,70,,192.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,257.25,75,,205.8,percent of total billed charges,75% of total billed charges for outpatient setting,284.69,83,,227.752,percent of total billed charges,83% of total billed charges for outpatient setting,171.5,50,,137.2,percent of total billed charges,50% of total billed charges for outpatient setting,171.5,50,,137.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.34,39.17,,107.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.05,284.69,
SURGIFOAM - GELATIN SPONGE ABS,90000242,CDM,270,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
TRAY - BLUE RHINO INTRODUCER,90000244,CDM,270,RC,,,outpatient,,,830,415,,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.72,38.4,,254.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,318.72,38.4,,254.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,622.5,75,,498,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,75,,498,percent of total billed charges,75% of total billed charges for outpatient setting,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,622.5,75,,498,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,290.5,35,,232.4,percent of total billed charges,35% of total billed charges for outpatient setting,647.4,78,,517.92,percent of total billed charges,78% of total billed charges for outpatient setting,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,581,70,,464.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,622.5,75,,498,percent of total billed charges,75% of total billed charges for outpatient setting,688.9,83,,551.12,percent of total billed charges,83% of total billed charges for outpatient setting,415,50,,332,percent of total billed charges,50% of total billed charges for outpatient setting,415,50,,332,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,325.09,39.17,,260.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,290.5,688.9,
ELECTRODE - 20X15 LOOP TUNGS,90000245,CDM,270,RC,,,outpatient,,,53,26.5,,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,20.35,38.4,,16.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.55,35,,14.84,percent of total billed charges,35% of total billed charges for outpatient setting,41.34,78,,33.072,percent of total billed charges,78% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,37.1,70,,29.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.75,75,,31.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.99,83,,35.192,percent of total billed charges,83% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,26.5,50,,21.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.76,39.17,,16.608,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.55,43.99,
LOOP - BLUE SENTINEL,90000246,CDM,270,RC,,,outpatient,,,12,6,,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.61,38.4,,3.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.2,35,,3.36,percent of total billed charges,35% of total billed charges for outpatient setting,9.36,78,,7.488,percent of total billed charges,78% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,8.4,70,,6.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9,75,,7.2,percent of total billed charges,75% of total billed charges for outpatient setting,9.96,83,,7.968,percent of total billed charges,83% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,6,50,,4.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.7,39.17,,3.76,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.2,9.96,
LOOP - RED MAXI LF VESSEL,90000247,CDM,270,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
LOOP - RED MD SENTINEL,90000248,CDM,270,RC,,,outpatient,,,16,8,,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.14,38.4,,4.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.6,35,,4.48,percent of total billed charges,35% of total billed charges for outpatient setting,12.48,78,,9.984,percent of total billed charges,78% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,11.2,70,,8.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12,75,,9.6,percent of total billed charges,75% of total billed charges for outpatient setting,13.28,83,,10.624,percent of total billed charges,83% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,8,50,,6.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.26,39.17,,5.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.6,13.28,
KIT - 6FR POWER PORT SLIM,90000250,CDM,270,RC,C1788,HCPCS,outpatient,,,1103,551.5,,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,423.55,38.4,,338.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,423.55,38.4,,338.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,827.25,75,,661.8,percent of total billed charges,75% of total billed charges for outpatient setting,827.25,75,,661.8,percent of total billed charges,75% of total billed charges for outpatient setting,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,827.25,75,,661.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,386.05,35,,308.84,percent of total billed charges,35% of total billed charges for outpatient setting,860.34,78,,688.272,percent of total billed charges,78% of total billed charges for outpatient setting,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,772.1,70,,617.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,827.25,75,,661.8,percent of total billed charges,75% of total billed charges for outpatient setting,915.49,83,,732.392,percent of total billed charges,83% of total billed charges for outpatient setting,551.5,50,,441.2,percent of total billed charges,50% of total billed charges for outpatient setting,551.5,50,,441.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,432.02,39.17,,345.616,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,386.05,915.49,
SET - 6FR INTRODUCER,90000251,CDM,270,RC,,,outpatient,,,183,91.5,,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.27,38.4,,56.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,70.27,38.4,,56.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.05,35,,51.24,percent of total billed charges,35% of total billed charges for outpatient setting,142.74,78,,114.192,percent of total billed charges,78% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,128.1,70,,102.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.25,75,,109.8,percent of total billed charges,75% of total billed charges for outpatient setting,151.89,83,,121.512,percent of total billed charges,83% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,91.5,50,,73.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.68,39.17,,57.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,64.05,151.89,
CATH - 6FR SINGLE LUMEN PORTAL,90000252,CDM,270,RC,,,outpatient,,,1060,530,,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,407.04,38.4,,325.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,407.04,38.4,,325.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,795,75,,636,percent of total billed charges,75% of total billed charges for outpatient setting,795,75,,636,percent of total billed charges,75% of total billed charges for outpatient setting,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,795,75,,636,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371,35,,296.8,percent of total billed charges,35% of total billed charges for outpatient setting,826.8,78,,661.44,percent of total billed charges,78% of total billed charges for outpatient setting,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,742,70,,593.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,795,75,,636,percent of total billed charges,75% of total billed charges for outpatient setting,879.8,83,,703.84,percent of total billed charges,83% of total billed charges for outpatient setting,530,50,,424,percent of total billed charges,50% of total billed charges for outpatient setting,530,50,,424,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,415.18,39.17,,332.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,371,879.8,
TRAY - 5FR PICC DUAL LUMEN,90000253,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
TRAY - 4FR PICC SINGLE LUMEN,90000254,CDM,270,RC,,,outpatient,,,765,382.5,,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,38.4,,235.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,293.76,38.4,,235.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,573.75,75,,459,percent of total billed charges,75% of total billed charges for outpatient setting,573.75,75,,459,percent of total billed charges,75% of total billed charges for outpatient setting,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,573.75,75,,459,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,267.75,35,,214.2,percent of total billed charges,35% of total billed charges for outpatient setting,596.7,78,,477.36,percent of total billed charges,78% of total billed charges for outpatient setting,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,535.5,70,,428.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,573.75,75,,459,percent of total billed charges,75% of total billed charges for outpatient setting,634.95,83,,507.96,percent of total billed charges,83% of total billed charges for outpatient setting,382.5,50,,306,percent of total billed charges,50% of total billed charges for outpatient setting,382.5,50,,306,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,299.64,39.17,,239.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,267.75,634.95,
BLADE - NARROW LONG,90000256,CDM,270,RC,,,outpatient,,,116,58,,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,44.54,38.4,,35.632,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.6,35,,32.48,percent of total billed charges,35% of total billed charges for outpatient setting,90.48,78,,72.384,percent of total billed charges,78% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,81.2,70,,64.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,96.28,83,,77.024,percent of total billed charges,83% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,58,50,,46.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.43,39.17,,36.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,40.6,96.28,
BLADE - WIDE MEDIUM LONG,90000258,CDM,270,RC,,,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
SHEAR - HARMONIC W/ SCISSOR,90000262,CDM,270,RC,,,outpatient,,,775,387.5,,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,297.6,38.4,,238.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.6,38.4,,238.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,581.25,75,,465,percent of total billed charges,75% of total billed charges for outpatient setting,581.25,75,,465,percent of total billed charges,75% of total billed charges for outpatient setting,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,581.25,75,,465,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,271.25,35,,217,percent of total billed charges,35% of total billed charges for outpatient setting,604.5,78,,483.6,percent of total billed charges,78% of total billed charges for outpatient setting,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,542.5,70,,434,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,581.25,75,,465,percent of total billed charges,75% of total billed charges for outpatient setting,643.25,83,,514.6,percent of total billed charges,83% of total billed charges for outpatient setting,387.5,50,,310,percent of total billed charges,50% of total billed charges for outpatient setting,387.5,50,,310,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,303.55,39.17,,242.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,271.25,643.25,
TUBE - 14FR T-TUBE,90000265,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
TUBE - 16FR T-TUBE,90000266,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
TUBE - 18FR T-TUBE,90000267,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
PUNCH - 6MM DERMAL BIOPSY,90000270,CDM,270,RC,,,outpatient,,,8,4,,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.07,38.4,,2.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.8,35,,2.24,percent of total billed charges,35% of total billed charges for outpatient setting,6.24,78,,4.992,percent of total billed charges,78% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,5.6,70,,4.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6,75,,4.8,percent of total billed charges,75% of total billed charges for outpatient setting,6.64,83,,5.312,percent of total billed charges,83% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,4,50,,3.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.13,39.17,,2.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.8,6.64,
PUNCH - 2MM DERMAL BIOPSY,90000271,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
PUNCH - 4MM DERMAL BIOPSY,90000272,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
PUNCH - 5MM DERMAL BIOPSY,90000273,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
DRAPE - VI-DRAPE ISOLATION BAG,90000274,CDM,270,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
KIT - 24FR  2.0 MIC-KEY LOW PR,90000275,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRESSING - OPTIFOAM HEEL 6X6,90000276,CDM,270,RC,,,outpatient,,,37,18.5,,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.21,38.4,,11.368,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.95,35,,10.36,percent of total billed charges,35% of total billed charges for outpatient setting,28.86,78,,23.088,percent of total billed charges,78% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,25.9,70,,20.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,27.75,75,,22.2,percent of total billed charges,75% of total billed charges for outpatient setting,30.71,83,,24.568,percent of total billed charges,83% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,18.5,50,,14.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.49,39.17,,11.592,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.95,30.71,
GEL - THERAHONEY,90000277,CDM,270,RC,,,outpatient,,,23,11.5,,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.83,38.4,,7.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.05,35,,6.44,percent of total billed charges,35% of total billed charges for outpatient setting,17.94,78,,14.352,percent of total billed charges,78% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,16.1,70,,12.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.25,75,,13.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.09,83,,15.272,percent of total billed charges,83% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,11.5,50,,9.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.01,39.17,,7.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.05,19.09,
KIT - 16FR SAFETY SINGLE PEG,90000278,CDM,270,RC,,,outpatient,,,315,157.5,,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.96,38.4,,96.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,120.96,38.4,,96.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,110.25,35,,88.2,percent of total billed charges,35% of total billed charges for outpatient setting,245.7,78,,196.56,percent of total billed charges,78% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,220.5,70,,176.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,236.25,75,,189,percent of total billed charges,75% of total billed charges for outpatient setting,261.45,83,,209.16,percent of total billed charges,83% of total billed charges for outpatient setting,157.5,50,,126,percent of total billed charges,50% of total billed charges for outpatient setting,157.5,50,,126,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123.38,39.17,,98.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,110.25,261.45,
TUBE - NASOGASTRIC 8FR 43,90000279,CDM,270,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
TUBE - NASOGASTRIC 10FR 43,90000280,CDM,270,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
TUBE - NASOGASTRIC 12FR 43,90000281,CDM,270,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
MESH - OPTIMIZED COMPOSITE,90000282,CDM,278,RC,C1781,HCPCS,both,,,993,496.5,,695.1,70,,556.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,381.31,38.4,,305.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,381.31,38.4,,305.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,695.1,70,,556.08,percent of total billed charges,70% of billed charges for implant carveouts,695.1,70,,556.08,percent of total billed charges,70% of billed charges for implant carveouts,695.1,70,,556.08,percent of total billed charges,70% of billed charges for implant carveouts,794.4,80,,635.52,percent of total billed charges,80% of billed charges for implant carveouts,794.4,80,,635.52,percent of total billed charges,80% of billed charges for implant carveouts,695.1,70,,556.08,percent of total billed charges,70% of billed charges for implant carveouts,794.4,80,,635.52,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,347.55,35,,278.04,percent of total billed charges,35% of total billed charges for outpatient setting,774.54,78,,619.632,percent of total billed charges,78% of total billed charges for outpatient setting,695.1,70,,556.08,percent of total billed charges,70% of total billed charges for outpatient setting,695.1,70,,556.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,744.75,75,,595.8,percent of total billed charges,75% of total billed charges for outpatient setting,824.19,83,,659.352,percent of total billed charges,83% of total billed charges for outpatient setting,496.5,50,,397.2,percent of total billed charges,50% of total billed charges for outpatient setting,496.5,50,,397.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,388.94,39.17,,311.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,347.55,824.19,
KIT - 24FR 3.5CM FEED G-TUBE MIC-KEY LP,90000283,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
KIT - 5FR PEDI SPECI-CATH 5FR NEONATAL,90000284,CDM,270,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
SUTURE - VICRYL 4-0 J218H,90000285,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
POUCH - 2.75 W/SUR-FIT DRAIN,90000286,CDM,270,RC,,,outpatient,,,47,23.5,,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.05,38.4,,14.44,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.45,35,,13.16,percent of total billed charges,35% of total billed charges for outpatient setting,36.66,78,,29.328,percent of total billed charges,78% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,32.9,70,,26.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,75,,28.2,percent of total billed charges,75% of total billed charges for outpatient setting,39.01,83,,31.208,percent of total billed charges,83% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,23.5,50,,18.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.41,39.17,,14.728,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.45,39.01,
SPLINT - SM RT PD FOREARM,90000287,CDM,274,RC,,,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
SPLINT - SM LT PAD FOREARM,90000288,CDM,274,RC,,,both,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,28,70,,22.4,percent of total billed charges,70% of total billed charges for outpatient setting,28,75,,22.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,28,
DRESSING - 6.1X5.6 W/SACRUM,90000289,CDM,270,RC,,,outpatient,,,38,19,,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.59,38.4,,11.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.3,35,,10.64,percent of total billed charges,35% of total billed charges for outpatient setting,29.64,78,,23.712,percent of total billed charges,78% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,26.6,70,,21.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.5,75,,22.8,percent of total billed charges,75% of total billed charges for outpatient setting,31.54,83,,25.232,percent of total billed charges,83% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,19,50,,15.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.88,39.17,,11.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,13.3,31.54,
C-COLLAR - NECKLESS PERFIT,90000290,CDM,270,RC,,,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.6,63.08,
PAD - HEARTSTART PEDS M3719A,90000291,CDM,270,RC,,,outpatient,,,113,56.5,,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.39,38.4,,34.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.55,35,,31.64,percent of total billed charges,35% of total billed charges for outpatient setting,88.14,78,,70.512,percent of total billed charges,78% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,79.1,70,,63.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.75,75,,67.8,percent of total billed charges,75% of total billed charges for outpatient setting,93.79,83,,75.032,percent of total billed charges,83% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,56.5,50,,45.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.26,39.17,,35.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.55,93.79,
CYROCUP,90000292,CDM,270,RC,,,outpatient,,,28,14,,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.75,38.4,,8.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.8,35,,7.84,percent of total billed charges,35% of total billed charges for outpatient setting,21.84,78,,17.472,percent of total billed charges,78% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,19.6,70,,15.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,75,,16.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.24,83,,18.592,percent of total billed charges,83% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,14,50,,11.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.97,39.17,,8.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.8,23.24,
DRESSING - 3X3 OPTILOC NONADHE,90000293,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
DRESSING - 5X5.5 OPTILOC NONAD,90000294,CDM,270,RC,,,outpatient,,,14,7,,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.38,38.4,,4.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.9,35,,3.92,percent of total billed charges,35% of total billed charges for outpatient setting,10.92,78,,8.736,percent of total billed charges,78% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,9.8,70,,7.84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,75,,8.4,percent of total billed charges,75% of total billed charges for outpatient setting,11.62,83,,9.296,percent of total billed charges,83% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,7,50,,5.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.49,39.17,,4.392,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.9,11.62,
CATH - 9.6FR HICKMAN SNGL LUME,90000295,CDM,270,RC,,,outpatient,,,387,193.5,,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.61,38.4,,118.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,148.61,38.4,,118.888,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,290.25,75,,232.2,percent of total billed charges,75% of total billed charges for outpatient setting,290.25,75,,232.2,percent of total billed charges,75% of total billed charges for outpatient setting,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,290.25,75,,232.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.45,35,,108.36,percent of total billed charges,35% of total billed charges for outpatient setting,301.86,78,,241.488,percent of total billed charges,78% of total billed charges for outpatient setting,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,270.9,70,,216.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,290.25,75,,232.2,percent of total billed charges,75% of total billed charges for outpatient setting,321.21,83,,256.968,percent of total billed charges,83% of total billed charges for outpatient setting,193.5,50,,154.8,percent of total billed charges,50% of total billed charges for outpatient setting,193.5,50,,154.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.58,39.17,,121.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,135.45,321.21,
CATH - 6.6FR BROVIAC VITACUFF,90000296,CDM,270,RC,,,outpatient,,,372,186,,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.85,38.4,,114.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.85,38.4,,114.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,130.2,35,,104.16,percent of total billed charges,35% of total billed charges for outpatient setting,290.16,78,,232.128,percent of total billed charges,78% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,260.4,70,,208.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,279,75,,223.2,percent of total billed charges,75% of total billed charges for outpatient setting,308.76,83,,247.008,percent of total billed charges,83% of total billed charges for outpatient setting,186,50,,148.8,percent of total billed charges,50% of total billed charges for outpatient setting,186,50,,148.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,145.71,39.17,,116.568,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,130.2,308.76,
DRESSING - MXRB AG 4.75X4,90000297,CDM,270,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
KIT - 14FR PERCUT CAVITY DRAIN,90000298,CDM,270,RC,,,outpatient,,,366,183,,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,140.54,38.4,,112.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,140.54,38.4,,112.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,274.5,75,,219.6,percent of total billed charges,75% of total billed charges for outpatient setting,274.5,75,,219.6,percent of total billed charges,75% of total billed charges for outpatient setting,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,274.5,75,,219.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.1,35,,102.48,percent of total billed charges,35% of total billed charges for outpatient setting,285.48,78,,228.384,percent of total billed charges,78% of total billed charges for outpatient setting,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,256.2,70,,204.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,274.5,75,,219.6,percent of total billed charges,75% of total billed charges for outpatient setting,303.78,83,,243.024,percent of total billed charges,83% of total billed charges for outpatient setting,183,50,,146.4,percent of total billed charges,50% of total billed charges for outpatient setting,183,50,,146.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,143.35,39.17,,114.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,128.1,303.78,
TUBE - 18FR 2.5 MIC-KEY LOWPRO,90000299,CDM,270,RC,,,outpatient,,,331,165.5,,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.85,35,,92.68,percent of total billed charges,35% of total billed charges for outpatient setting,258.18,78,,206.544,percent of total billed charges,78% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,274.73,83,,219.784,percent of total billed charges,83% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.64,39.17,,103.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.85,274.73,
SET - THORACENTESIS,90000300,CDM,270,RC,,,outpatient,,,20,10,,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7.68,38.4,,6.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7,35,,5.6,percent of total billed charges,35% of total billed charges for outpatient setting,15.6,78,,12.48,percent of total billed charges,78% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,14,70,,11.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15,75,,12,percent of total billed charges,75% of total billed charges for outpatient setting,16.6,83,,13.28,percent of total billed charges,83% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,10,50,,8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.83,39.17,,6.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7,16.6,
HANDLE - GIA UNIV ULTRA ENDO,90000301,CDM,270,RC,,,outpatient,,,951,475.5,,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.18,38.4,,292.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,365.18,38.4,,292.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,713.25,75,,570.6,percent of total billed charges,75% of total billed charges for outpatient setting,713.25,75,,570.6,percent of total billed charges,75% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,713.25,75,,570.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,332.85,35,,266.28,percent of total billed charges,35% of total billed charges for outpatient setting,741.78,78,,593.424,percent of total billed charges,78% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,665.7,70,,532.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,713.25,75,,570.6,percent of total billed charges,75% of total billed charges for outpatient setting,789.33,83,,631.464,percent of total billed charges,83% of total billed charges for outpatient setting,475.5,50,,380.4,percent of total billed charges,50% of total billed charges for outpatient setting,475.5,50,,380.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,372.48,39.17,,297.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,332.85,789.33,
RELOAD - 45MM VASCULAR GIA END,90000302,CDM,270,RC,,,outpatient,,,1161,580.5,,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,445.82,38.4,,356.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,445.82,38.4,,356.656,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,870.75,75,,696.6,percent of total billed charges,75% of total billed charges for outpatient setting,870.75,75,,696.6,percent of total billed charges,75% of total billed charges for outpatient setting,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,870.75,75,,696.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,406.35,35,,325.08,percent of total billed charges,35% of total billed charges for outpatient setting,905.58,78,,724.464,percent of total billed charges,78% of total billed charges for outpatient setting,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,812.7,70,,650.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,870.75,75,,696.6,percent of total billed charges,75% of total billed charges for outpatient setting,963.63,83,,770.904,percent of total billed charges,83% of total billed charges for outpatient setting,580.5,50,,464.4,percent of total billed charges,50% of total billed charges for outpatient setting,580.5,50,,464.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,454.74,39.17,,363.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,406.35,963.63,
RELOAD - 45MM MD/VASCULAR ENDO,90000303,CDM,270,RC,,,outpatient,,,1182,591,,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,453.89,38.4,,363.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,453.89,38.4,,363.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,886.5,75,,709.2,percent of total billed charges,75% of total billed charges for outpatient setting,886.5,75,,709.2,percent of total billed charges,75% of total billed charges for outpatient setting,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,886.5,75,,709.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,413.7,35,,330.96,percent of total billed charges,35% of total billed charges for outpatient setting,921.96,78,,737.568,percent of total billed charges,78% of total billed charges for outpatient setting,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,827.4,70,,661.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,886.5,75,,709.2,percent of total billed charges,75% of total billed charges for outpatient setting,981.06,83,,784.848,percent of total billed charges,83% of total billed charges for outpatient setting,591,50,,472.8,percent of total billed charges,50% of total billed charges for outpatient setting,591,50,,472.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,462.97,39.17,,370.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,413.7,981.06,
DEVICE - HEMOSTATIC CLIP 235CM,90000304,CDM,270,RC,,,outpatient,,,433,216.5,,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.27,38.4,,133.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,166.27,38.4,,133.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,151.55,35,,121.24,percent of total billed charges,35% of total billed charges for outpatient setting,337.74,78,,270.192,percent of total billed charges,78% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,303.1,70,,242.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,324.75,75,,259.8,percent of total billed charges,75% of total billed charges for outpatient setting,359.39,83,,287.512,percent of total billed charges,83% of total billed charges for outpatient setting,216.5,50,,173.2,percent of total billed charges,50% of total billed charges for outpatient setting,216.5,50,,173.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,169.6,39.17,,135.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,151.55,359.39,
STAPLER - 35 REG PROXIMATE PLU,90000305,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
MESH - 6X8  CQUR MOSAIC ATRIUM,90000306,CDM,278,RC,,,both,,,1585,792.5,,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,608.64,38.4,,486.912,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1109.5,70,,887.6,percent of total billed charges,70% of billed charges for implant carveouts,1109.5,70,,887.6,percent of total billed charges,70% of billed charges for implant carveouts,1109.5,70,,887.6,percent of total billed charges,70% of billed charges for implant carveouts,1268,80,,1014.4,percent of total billed charges,80% of billed charges for implant carveouts,1268,80,,1014.4,percent of total billed charges,80% of billed charges for implant carveouts,1109.5,70,,887.6,percent of total billed charges,70% of billed charges for implant carveouts,1268,80,,1014.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,554.75,35,,443.8,percent of total billed charges,35% of total billed charges for outpatient setting,1236.3,78,,989.04,percent of total billed charges,78% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,1109.5,70,,887.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1188.75,75,,951,percent of total billed charges,75% of total billed charges for outpatient setting,1315.55,83,,1052.44,percent of total billed charges,83% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,792.5,50,,634,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,620.81,39.17,,496.648,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,554.75,1315.55,
MESH - 8X10 CQUR MOSIAC ATRIUM,90000307,CDM,278,RC,,,both,,,3637,1818.5,,2545.9,70,,2036.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1396.61,38.4,,1117.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1396.61,38.4,,1117.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2545.9,70,,2036.72,percent of total billed charges,70% of billed charges for implant carveouts,2545.9,70,,2036.72,percent of total billed charges,70% of billed charges for implant carveouts,2545.9,70,,2036.72,percent of total billed charges,70% of billed charges for implant carveouts,2909.6,80,,2327.68,percent of total billed charges,80% of billed charges for implant carveouts,2909.6,80,,2327.68,percent of total billed charges,80% of billed charges for implant carveouts,2545.9,70,,2036.72,percent of total billed charges,70% of billed charges for implant carveouts,2909.6,80,,2327.68,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1272.95,35,,1018.36,percent of total billed charges,35% of total billed charges for outpatient setting,2836.86,78,,2269.488,percent of total billed charges,78% of total billed charges for outpatient setting,2545.9,70,,2036.72,percent of total billed charges,70% of total billed charges for outpatient setting,2545.9,70,,2036.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2727.75,75,,2182.2,percent of total billed charges,75% of total billed charges for outpatient setting,3018.71,83,,2414.968,percent of total billed charges,83% of total billed charges for outpatient setting,1818.5,50,,1454.8,percent of total billed charges,50% of total billed charges for outpatient setting,1818.5,50,,1454.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1424.54,39.17,,1139.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1272.95,3018.71,
MESH - 4.3X5.5  CQUR MOSAIC AT,90000308,CDM,278,RC,,,both,,,1105,552.5,,773.5,70,,618.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,424.32,38.4,,339.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,424.32,38.4,,339.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,773.5,70,,618.8,percent of total billed charges,70% of billed charges for implant carveouts,773.5,70,,618.8,percent of total billed charges,70% of billed charges for implant carveouts,773.5,70,,618.8,percent of total billed charges,70% of billed charges for implant carveouts,884,80,,707.2,percent of total billed charges,80% of billed charges for implant carveouts,884,80,,707.2,percent of total billed charges,80% of billed charges for implant carveouts,773.5,70,,618.8,percent of total billed charges,70% of billed charges for implant carveouts,884,80,,707.2,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,386.75,35,,309.4,percent of total billed charges,35% of total billed charges for outpatient setting,861.9,78,,689.52,percent of total billed charges,78% of total billed charges for outpatient setting,773.5,70,,618.8,percent of total billed charges,70% of total billed charges for outpatient setting,773.5,70,,618.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,828.75,75,,663,percent of total billed charges,75% of total billed charges for outpatient setting,917.15,83,,733.72,percent of total billed charges,83% of total billed charges for outpatient setting,552.5,50,,442,percent of total billed charges,50% of total billed charges for outpatient setting,552.5,50,,442,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,432.81,39.17,,346.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,386.75,917.15,
SUTURE - 8623H 2-0 PROLENE,90000309,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
ANCHOR - 5.5MM TWINFIX 7209105,90000311,CDM,278,RC,,,both,,,348,174,,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,133.63,38.4,,106.904,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,348,70,,278.4,percent of total billed charges,70% of total billed charges for outpatient setting,348,70,,278.4,percent of total billed charges,70% of total billed charges for outpatient setting,348,70,,278.4,percent of total billed charges,70% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,348,70,,278.4,percent of total billed charges,70% of total billed charges for outpatient setting,348,75,,278.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,121.8,35,,97.44,percent of total billed charges,35% of total billed charges for outpatient setting,271.44,78,,217.152,percent of total billed charges,78% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,243.6,70,,194.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,261,75,,208.8,percent of total billed charges,75% of total billed charges for outpatient setting,288.84,83,,231.072,percent of total billed charges,83% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,174,50,,139.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,136.3,39.17,,109.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,121.8,348,
BLADE - 3.5MM RESECTOR ARTHRO,90000312,CDM,270,RC,,,outpatient,,,250,125,,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,96,38.4,,76.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,87.5,35,,70,percent of total billed charges,35% of total billed charges for outpatient setting,195,78,,156,percent of total billed charges,78% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,175,70,,140,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,187.5,75,,150,percent of total billed charges,75% of total billed charges for outpatient setting,207.5,83,,166,percent of total billed charges,83% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,125,50,,100,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,97.92,39.17,,78.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,87.5,207.5,
EOVIST 10ML,90000313,CDM,270,RC,,,outpatient,,,422,211,,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,162.05,38.4,,129.64,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.7,35,,118.16,percent of total billed charges,35% of total billed charges for outpatient setting,329.16,78,,263.328,percent of total billed charges,78% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,295.4,70,,236.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,316.5,75,,253.2,percent of total billed charges,75% of total billed charges for outpatient setting,350.26,83,,280.208,percent of total billed charges,83% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,211,50,,168.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.29,39.17,,132.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147.7,350.26,
BANDAGE - PROFORE LITE SYSTEM,90000314,CDM,270,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
WRAP - ACE 4  DOUBLE LENGTH,90000315,CDM,270,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
KIT - 18FR 2.3 MIC-KEY GASTRO,90000316,CDM,270,RC,,,outpatient,,,331,165.5,,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,127.1,38.4,,101.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.85,35,,92.68,percent of total billed charges,35% of total billed charges for outpatient setting,258.18,78,,206.544,percent of total billed charges,78% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,231.7,70,,185.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,248.25,75,,198.6,percent of total billed charges,75% of total billed charges for outpatient setting,274.73,83,,219.784,percent of total billed charges,83% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,165.5,50,,132.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.64,39.17,,103.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.85,274.73,
PROBE - 7GA BIOPSY ENCORE,90000317,CDM,270,RC,,,outpatient,,,703,351.5,,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,269.95,38.4,,215.96,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,246.05,35,,196.84,percent of total billed charges,35% of total billed charges for outpatient setting,548.34,78,,438.672,percent of total billed charges,78% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,492.1,70,,393.68,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,527.25,75,,421.8,percent of total billed charges,75% of total billed charges for outpatient setting,583.49,83,,466.792,percent of total billed charges,83% of total billed charges for outpatient setting,351.5,50,,281.2,percent of total billed charges,50% of total billed charges for outpatient setting,351.5,50,,281.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,275.35,39.17,,220.28,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,246.05,583.49,
ANCHOR - 5MM TWINFIX 721708,90000318,CDM,270,RC,,,outpatient,,,268,134,,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.91,38.4,,82.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.91,38.4,,82.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.8,35,,75.04,percent of total billed charges,35% of total billed charges for outpatient setting,209.04,78,,167.232,percent of total billed charges,78% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,187.6,70,,150.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201,75,,160.8,percent of total billed charges,75% of total billed charges for outpatient setting,222.44,83,,177.952,percent of total billed charges,83% of total billed charges for outpatient setting,134,50,,107.2,percent of total billed charges,50% of total billed charges for outpatient setting,134,50,,107.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.97,39.17,,83.976,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,93.8,222.44,
STATLOCK - PICC PLUS TRICOT,90000319,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
K WIRE - 292.10,90000320,CDM,278,RC,,,both,,,57,28.5,,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.89,38.4,,17.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57,70,,45.6,percent of total billed charges,70% of total billed charges for outpatient setting,57,70,,45.6,percent of total billed charges,70% of total billed charges for outpatient setting,57,70,,45.6,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,70,,45.6,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.95,35,,15.96,percent of total billed charges,35% of total billed charges for outpatient setting,44.46,78,,35.568,percent of total billed charges,78% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,39.9,70,,31.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.75,75,,34.2,percent of total billed charges,75% of total billed charges for outpatient setting,47.31,83,,37.848,percent of total billed charges,83% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,28.5,50,,22.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.33,39.17,,17.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.95,57,
K WIRE - 292.79,90000321,CDM,278,RC,,,both,,,154,77,,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.14,38.4,,47.312,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,75,,123.2,percent of total billed charges,75% of total billed charges for outpatient setting,154,75,,123.2,percent of total billed charges,75% of total billed charges for outpatient setting,154,70,,123.2,percent of total billed charges,70% of total billed charges for outpatient setting,154,75,,123.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.9,35,,43.12,percent of total billed charges,35% of total billed charges for outpatient setting,120.12,78,,96.096,percent of total billed charges,78% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,107.8,70,,86.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,75,,92.4,percent of total billed charges,75% of total billed charges for outpatient setting,127.82,83,,102.256,percent of total billed charges,83% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,77,50,,61.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,60.32,39.17,,48.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,53.9,154,
CATH - 10FR WORD BARTHOLIN,90000322,CDM,270,RC,,,outpatient,,,62,31,,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.81,38.4,,19.048,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.7,35,,17.36,percent of total billed charges,35% of total billed charges for outpatient setting,48.36,78,,38.688,percent of total billed charges,78% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,43.4,70,,34.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.5,75,,37.2,percent of total billed charges,75% of total billed charges for outpatient setting,51.46,83,,41.168,percent of total billed charges,83% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,31,50,,24.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.29,39.17,,19.432,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.7,51.46,
TUBE - 4.0MM CRICOTHYROTOMY,90000324,CDM,270,RC,,,outpatient,,,421,210.5,,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.35,35,,117.88,percent of total billed charges,35% of total billed charges for outpatient setting,328.38,78,,262.704,percent of total billed charges,78% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,349.43,83,,279.544,percent of total billed charges,83% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.89,39.17,,131.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147.35,349.43,
TUBE - 2.0MM CRICOTHYROTOMY,90000325,CDM,270,RC,,,outpatient,,,421,210.5,,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,161.66,38.4,,129.328,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147.35,35,,117.88,percent of total billed charges,35% of total billed charges for outpatient setting,328.38,78,,262.704,percent of total billed charges,78% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,294.7,70,,235.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,315.75,75,,252.6,percent of total billed charges,75% of total billed charges for outpatient setting,349.43,83,,279.544,percent of total billed charges,83% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,210.5,50,,168.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,164.89,39.17,,131.912,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,147.35,349.43,
WIRE - 1.25 K,90000326,CDM,278,RC,,,both,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41,70,,32.8,percent of total billed charges,70% of total billed charges for outpatient setting,41,70,,32.8,percent of total billed charges,70% of total billed charges for outpatient setting,41,70,,32.8,percent of total billed charges,70% of total billed charges for outpatient setting,41,75,,32.8,percent of total billed charges,75% of total billed charges for outpatient setting,41,75,,32.8,percent of total billed charges,75% of total billed charges for outpatient setting,41,70,,32.8,percent of total billed charges,70% of total billed charges for outpatient setting,41,75,,32.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,41,
AIRWAY - ESO TRACH COMBO 37FR,90000327,CDM,270,RC,,,outpatient,,,167,83.5,,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,64.13,38.4,,51.304,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.45,35,,46.76,percent of total billed charges,35% of total billed charges for outpatient setting,130.26,78,,104.208,percent of total billed charges,78% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,116.9,70,,93.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.25,75,,100.2,percent of total billed charges,75% of total billed charges for outpatient setting,138.61,83,,110.888,percent of total billed charges,83% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,83.5,50,,66.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.41,39.17,,52.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,58.45,138.61,
MESH - 4.3CM SM C-QUR V-PATCH,90000328,CDM,278,RC,,,both,,,952,476,,666.4,70,,533.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,365.57,38.4,,292.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,365.57,38.4,,292.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,666.4,70,,533.12,percent of total billed charges,70% of billed charges for implant carveouts,666.4,70,,533.12,percent of total billed charges,70% of billed charges for implant carveouts,666.4,70,,533.12,percent of total billed charges,70% of billed charges for implant carveouts,761.6,80,,609.28,percent of total billed charges,80% of billed charges for implant carveouts,761.6,80,,609.28,percent of total billed charges,80% of billed charges for implant carveouts,666.4,70,,533.12,percent of total billed charges,70% of billed charges for implant carveouts,761.6,80,,609.28,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,333.2,35,,266.56,percent of total billed charges,35% of total billed charges for outpatient setting,742.56,78,,594.048,percent of total billed charges,78% of total billed charges for outpatient setting,666.4,70,,533.12,percent of total billed charges,70% of total billed charges for outpatient setting,666.4,70,,533.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,714,75,,571.2,percent of total billed charges,75% of total billed charges for outpatient setting,790.16,83,,632.128,percent of total billed charges,83% of total billed charges for outpatient setting,476,50,,380.8,percent of total billed charges,50% of total billed charges for outpatient setting,476,50,,380.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,372.88,39.17,,298.304,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,333.2,790.16,
MESH - 6.4CM MD C-QUR V-PATCH,90000329,CDM,278,RC,,,both,,,1677,838.5,,1173.9,70,,939.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,643.97,38.4,,515.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,643.97,38.4,,515.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1173.9,70,,939.12,percent of total billed charges,70% of billed charges for implant carveouts,1173.9,70,,939.12,percent of total billed charges,70% of billed charges for implant carveouts,1173.9,70,,939.12,percent of total billed charges,70% of billed charges for implant carveouts,1341.6,80,,1073.28,percent of total billed charges,80% of billed charges for implant carveouts,1341.6,80,,1073.28,percent of total billed charges,80% of billed charges for implant carveouts,1173.9,70,,939.12,percent of total billed charges,70% of billed charges for implant carveouts,1341.6,80,,1073.28,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,586.95,35,,469.56,percent of total billed charges,35% of total billed charges for outpatient setting,1308.06,78,,1046.448,percent of total billed charges,78% of total billed charges for outpatient setting,1173.9,70,,939.12,percent of total billed charges,70% of total billed charges for outpatient setting,1173.9,70,,939.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1257.75,75,,1006.2,percent of total billed charges,75% of total billed charges for outpatient setting,1391.91,83,,1113.528,percent of total billed charges,83% of total billed charges for outpatient setting,838.5,50,,670.8,percent of total billed charges,50% of total billed charges for outpatient setting,838.5,50,,670.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,656.85,39.17,,525.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,586.95,1391.91,
KIT - 18FR 4.0CM MIC-KEY LP GT,90000330,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBE - 30FR GASTRO FEED MIC,90000331,CDM,270,RC,,,outpatient,,,120,60,,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,46.08,38.4,,36.864,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42,35,,33.6,percent of total billed charges,35% of total billed charges for outpatient setting,93.6,78,,74.88,percent of total billed charges,78% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,84,70,,67.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,90,75,,72,percent of total billed charges,75% of total billed charges for outpatient setting,99.6,83,,79.68,percent of total billed charges,83% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,60,50,,48,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,47,39.17,,37.6,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,42,99.6,
GEL - THERAHONEY 1.5OZ TB DRES,90000332,CDM,270,RC,,,outpatient,,,73,36.5,,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.03,38.4,,22.424,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,25.55,35,,20.44,percent of total billed charges,35% of total billed charges for outpatient setting,56.94,78,,45.552,percent of total billed charges,78% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,51.1,70,,40.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.75,75,,43.8,percent of total billed charges,75% of total billed charges for outpatient setting,60.59,83,,48.472,percent of total billed charges,83% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,36.5,50,,29.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,28.59,39.17,,22.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,25.55,60.59,
K WIRE - 292.25,90000333,CDM,278,RC,,,both,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,50,70,,40,percent of total billed charges,70% of total billed charges for outpatient setting,50,75,,40,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,50,
K WIRE - 292.12 SS,90000334,CDM,278,RC,,,both,,,55,27.5,,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.12,38.4,,16.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,55,70,,44,percent of total billed charges,70% of total billed charges for outpatient setting,55,70,,44,percent of total billed charges,70% of total billed charges for outpatient setting,55,70,,44,percent of total billed charges,70% of total billed charges for outpatient setting,55,75,,44,percent of total billed charges,75% of total billed charges for outpatient setting,55,75,,44,percent of total billed charges,75% of total billed charges for outpatient setting,55,70,,44,percent of total billed charges,70% of total billed charges for outpatient setting,55,75,,44,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.25,35,,15.4,percent of total billed charges,35% of total billed charges for outpatient setting,42.9,78,,34.32,percent of total billed charges,78% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,38.5,70,,30.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.25,75,,33,percent of total billed charges,75% of total billed charges for outpatient setting,45.65,83,,36.52,percent of total billed charges,83% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,27.5,50,,22,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.54,39.17,,17.232,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,19.25,55,
DRESSING - 4X4X.25 MCRBL (RTD) DERMA BLU,90000335,CDM,270,RC,,,outpatient,,,61,30.5,,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.42,38.4,,18.736,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21.35,35,,17.08,percent of total billed charges,35% of total billed charges for outpatient setting,47.58,78,,38.064,percent of total billed charges,78% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,42.7,70,,34.16,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45.75,75,,36.6,percent of total billed charges,75% of total billed charges for outpatient setting,50.63,83,,40.504,percent of total billed charges,83% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,30.5,50,,24.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.89,39.17,,19.112,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21.35,50.63,
DRESSING - MXRB AG 2X2,90000336,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
DRESSING - AG CAL 2X2,90000337,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
DRESSING - AG CAL 4X4,90000338,CDM,270,RC,,,outpatient,,,17,8.5,,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.53,38.4,,5.224,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.95,35,,4.76,percent of total billed charges,35% of total billed charges for outpatient setting,13.26,78,,10.608,percent of total billed charges,78% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,11.9,70,,9.52,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.75,75,,10.2,percent of total billed charges,75% of total billed charges for outpatient setting,14.11,83,,11.288,percent of total billed charges,83% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,8.5,50,,6.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.66,39.17,,5.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.95,14.11,
BANDAGE - COBAN 2 LAYER,90000339,CDM,270,RC,,,outpatient,,,52,26,,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.97,38.4,,15.976,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.2,35,,14.56,percent of total billed charges,35% of total billed charges for outpatient setting,40.56,78,,32.448,percent of total billed charges,78% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,36.4,70,,29.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39,75,,31.2,percent of total billed charges,75% of total billed charges for outpatient setting,43.16,83,,34.528,percent of total billed charges,83% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,26,50,,20.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.37,39.17,,16.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,18.2,43.16,
WAND - EVAC 70 PLASMA,90000340,CDM,270,RC,,,outpatient,,,644,322,,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.3,38.4,,197.84,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.4,35,,180.32,percent of total billed charges,35% of total billed charges for outpatient setting,502.32,78,,401.856,percent of total billed charges,78% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,450.8,70,,360.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483,75,,386.4,percent of total billed charges,75% of total billed charges for outpatient setting,534.52,83,,427.616,percent of total billed charges,83% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,322,50,,257.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.25,39.17,,201.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.4,534.52,
WAND - PRECISE EZ VIEW,90000341,CDM,270,RC,,,outpatient,,,354,177,,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,135.94,38.4,,108.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,123.9,35,,99.12,percent of total billed charges,35% of total billed charges for outpatient setting,276.12,78,,220.896,percent of total billed charges,78% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,247.8,70,,198.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,265.5,75,,212.4,percent of total billed charges,75% of total billed charges for outpatient setting,293.82,83,,235.056,percent of total billed charges,83% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,177,50,,141.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,138.66,39.17,,110.928,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,123.9,293.82,
DRESSING - 4X4 QUICKCLOT HEMOS,90000342,CDM,270,RC,,,outpatient,,,90,45,,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.56,38.4,,27.648,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.5,35,,25.2,percent of total billed charges,35% of total billed charges for outpatient setting,70.2,78,,56.16,percent of total billed charges,78% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,63,70,,50.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,67.5,75,,54,percent of total billed charges,75% of total billed charges for outpatient setting,74.7,83,,59.76,percent of total billed charges,83% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,45,50,,36,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.25,39.17,,28.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.5,74.7,
ANGIOCATH - 14GAX5.25  SPECIAL,90000343,CDM,270,RC,,,outpatient,,,59,29.5,,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.66,38.4,,18.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.65,35,,16.52,percent of total billed charges,35% of total billed charges for outpatient setting,46.02,78,,36.816,percent of total billed charges,78% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,41.3,70,,33.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,44.25,75,,35.4,percent of total billed charges,75% of total billed charges for outpatient setting,48.97,83,,39.176,percent of total billed charges,83% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,29.5,50,,23.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.11,39.17,,18.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.65,48.97,
TUBE - 3.0CM 20FR MIC-KEY GAST,90000344,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBE - 24FR 4.0 MIC-KEY LOPRO,90000345,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUTURE - ETHILON 1864g 4/0,90000349,CDM,270,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
SUTURE - VICRYL VCP322H 1,90000350,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
SUTURE - PROLENE 8412H 0,90000351,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
SUTURE - PROLENE 8434H 0,90000352,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
SUTURE - PDSII 0 CT-2 Z334HMON,90000353,CDM,270,RC,,,outpatient,,,13,6.5,,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.99,38.4,,3.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4.55,35,,3.64,percent of total billed charges,35% of total billed charges for outpatient setting,10.14,78,,8.112,percent of total billed charges,78% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,9.1,70,,7.28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.75,75,,7.8,percent of total billed charges,75% of total billed charges for outpatient setting,10.79,83,,8.632,percent of total billed charges,83% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,6.5,50,,5.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.09,39.17,,4.072,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,4.55,10.79,
SUTURE - VICRYL VCP496G 4/0,90000354,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
SUTURE - PDS II Z494G 4/0,90000355,CDM,270,RC,,,outpatient,,,24,12,,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.22,38.4,,7.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.4,35,,6.72,percent of total billed charges,35% of total billed charges for outpatient setting,18.72,78,,14.976,percent of total billed charges,78% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,16.8,70,,13.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18,75,,14.4,percent of total billed charges,75% of total billed charges for outpatient setting,19.92,83,,15.936,percent of total billed charges,83% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,12,50,,9.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.4,39.17,,7.52,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,8.4,19.92,
SUTURE - ETHILON 698G 5/0,90000356,CDM,270,RC,,,outpatient,,,15,7.5,,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,5.76,38.4,,4.608,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,35,,4.2,percent of total billed charges,35% of total billed charges for outpatient setting,11.7,78,,9.36,percent of total billed charges,78% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,10.5,70,,8.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.25,75,,9,percent of total billed charges,75% of total billed charges for outpatient setting,12.45,83,,9.96,percent of total billed charges,83% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,7.5,50,,6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.88,39.17,,4.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,5.25,12.45,
SUTURE - VICRYL VCP333H 2/0,90000357,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
SUTURE - ETHILON 1893G 3/0,90000358,CDM,270,RC,,,outpatient,,,45,22.5,,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.28,38.4,,13.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,35,,12.6,percent of total billed charges,35% of total billed charges for outpatient setting,35.1,78,,28.08,percent of total billed charges,78% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,31.5,70,,25.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.75,75,,27,percent of total billed charges,75% of total billed charges for outpatient setting,37.35,83,,29.88,percent of total billed charges,83% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,22.5,50,,18,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.63,39.17,,14.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.75,37.35,
SUTURE - PROLENE 8618G 5/0,90000359,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SUTURE - SILK C027D 0,90000360,CDM,270,RC,,,outpatient,,,33,16.5,,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.67,38.4,,10.136,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.55,35,,9.24,percent of total billed charges,35% of total billed charges for outpatient setting,25.74,78,,20.592,percent of total billed charges,78% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,23.1,70,,18.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24.75,75,,19.8,percent of total billed charges,75% of total billed charges for outpatient setting,27.39,83,,21.912,percent of total billed charges,83% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,16.5,50,,13.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.92,39.17,,10.336,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.55,27.39,
SUTURE - PROLENE 8619G 4/0,90000361,CDM,270,RC,,,outpatient,,,44,22,,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.9,38.4,,13.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.4,35,,12.32,percent of total billed charges,35% of total billed charges for outpatient setting,34.32,78,,27.456,percent of total billed charges,78% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,30.8,70,,24.64,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33,75,,26.4,percent of total billed charges,75% of total billed charges for outpatient setting,36.52,83,,29.216,percent of total billed charges,83% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,22,50,,17.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.24,39.17,,13.792,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.4,36.52,
BLADE - #3 MILLER GREENLINE FI,90001154,CDM,270,RC,,,outpatient,,,930,465,,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,357.12,38.4,,285.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.12,38.4,,285.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,325.5,35,,260.4,percent of total billed charges,35% of total billed charges for outpatient setting,725.4,78,,580.32,percent of total billed charges,78% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,771.9,83,,617.52,percent of total billed charges,83% of total billed charges for outpatient setting,465,50,,372,percent of total billed charges,50% of total billed charges for outpatient setting,465,50,,372,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,364.26,39.17,,291.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,325.5,771.9,
BOX - STORAGE CONTROL,90001253,CDM,270,RC,,,outpatient,,,290,145,,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,111.36,38.4,,89.088,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,101.5,35,,81.2,percent of total billed charges,35% of total billed charges for outpatient setting,226.2,78,,180.96,percent of total billed charges,78% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,203,70,,162.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,217.5,75,,174,percent of total billed charges,75% of total billed charges for outpatient setting,240.7,83,,192.56,percent of total billed charges,83% of total billed charges for outpatient setting,145,50,,116,percent of total billed charges,50% of total billed charges for outpatient setting,145,50,,116,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,113.59,39.17,,90.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,101.5,240.7,
CATH - 18FR COUDE BALLOON TIP,90001600,CDM,270,RC,,,outpatient,,,43,21.5,,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,16.51,38.4,,13.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.05,35,,12.04,percent of total billed charges,35% of total billed charges for outpatient setting,33.54,78,,26.832,percent of total billed charges,78% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,30.1,70,,24.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.25,75,,25.8,percent of total billed charges,75% of total billed charges for outpatient setting,35.69,83,,28.552,percent of total billed charges,83% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,21.5,50,,17.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.84,39.17,,13.472,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,15.05,35.69,
C-COLLAR - INF/PED ADJ PERFIT,90001617,CDM,270,RC,,,outpatient,,,76,38,,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,29.18,38.4,,23.344,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.6,35,,21.28,percent of total billed charges,35% of total billed charges for outpatient setting,59.28,78,,47.424,percent of total billed charges,78% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,53.2,70,,42.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57,75,,45.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.08,83,,50.464,percent of total billed charges,83% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,38,50,,30.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.76,39.17,,23.808,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,26.6,63.08,
DRESSING - 4 X6YD UNNA BOOT CA,90002424,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
FIOS - KII X 5X100 Z -THRU,90002923,CDM,270,RC,,,outpatient,,,91,45.5,,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,34.94,38.4,,27.952,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.85,35,,25.48,percent of total billed charges,35% of total billed charges for outpatient setting,70.98,78,,56.784,percent of total billed charges,78% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,63.7,70,,50.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.25,75,,54.6,percent of total billed charges,75% of total billed charges for outpatient setting,75.53,83,,60.424,percent of total billed charges,83% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,45.5,50,,36.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,35.64,39.17,,28.512,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,31.85,75.53,
GAUZE - HONEY THERAPY 4X5,90003202,CDM,270,RC,,,outpatient,,,30,15,,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.52,38.4,,9.216,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.5,35,,8.4,percent of total billed charges,35% of total billed charges for outpatient setting,23.4,78,,18.72,percent of total billed charges,78% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,21,70,,16.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.5,75,,18,percent of total billed charges,75% of total billed charges for outpatient setting,24.9,83,,19.92,percent of total billed charges,83% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,15,50,,12,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.75,39.17,,9.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.5,24.9,
HOLDER - ADULT ENDOTRACH TUBE,90003449,CDM,270,RC,,,outpatient,,,58,29,,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.27,38.4,,17.816,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.3,35,,16.24,percent of total billed charges,35% of total billed charges for outpatient setting,45.24,78,,36.192,percent of total billed charges,78% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,40.6,70,,32.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.5,75,,34.8,percent of total billed charges,75% of total billed charges for outpatient setting,48.14,83,,38.512,percent of total billed charges,83% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,29,50,,23.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,22.72,39.17,,18.176,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,20.3,48.14,
LIGACLIP - MED/LG,90004281,CDM,270,RC,,,outpatient,,,240,120,,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,92.16,38.4,,73.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,35,,67.2,percent of total billed charges,35% of total billed charges for outpatient setting,187.2,78,,149.76,percent of total billed charges,78% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,168,70,,134.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,199.2,83,,159.36,percent of total billed charges,83% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,120,50,,96,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,94,39.17,,75.2,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,84,199.2,
LOOPS - DEV-O MAXI RED,90004360,CDM,270,RC,,,outpatient,,,9,4.5,,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.46,38.4,,2.768,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.15,35,,2.52,percent of total billed charges,35% of total billed charges for outpatient setting,7.02,78,,5.616,percent of total billed charges,78% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,6.3,70,,5.04,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.75,75,,5.4,percent of total billed charges,75% of total billed charges for outpatient setting,7.47,83,,5.976,percent of total billed charges,83% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,4.5,50,,3.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.53,39.17,,2.824,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.15,7.47,
MASK - LG F&P ESON NASAL,90004564,CDM,270,RC,,,outpatient,,,4,2,,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1.54,38.4,,1.232,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.4,35,,1.12,percent of total billed charges,35% of total billed charges for outpatient setting,3.12,78,,2.496,percent of total billed charges,78% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,2.8,70,,2.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3,75,,2.4,percent of total billed charges,75% of total billed charges for outpatient setting,3.32,83,,2.656,percent of total billed charges,83% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,2,50,,1.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1.57,39.17,,1.256,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1.4,3.32,
MASK - CHILD SCENTED,90004568,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
RELOAD - 6R45B LINEAR CUTTER,90006194,CDM,270,RC,,,outpatient,,,1960,980,,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,752.64,38.4,,602.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,752.64,38.4,,602.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,1470,75,,1176,percent of total billed charges,75% of total billed charges for outpatient setting,1470,75,,1176,percent of total billed charges,75% of total billed charges for outpatient setting,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,1470,75,,1176,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,686,35,,548.8,percent of total billed charges,35% of total billed charges for outpatient setting,1528.8,78,,1223.04,percent of total billed charges,78% of total billed charges for outpatient setting,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,1372,70,,1097.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1470,75,,1176,percent of total billed charges,75% of total billed charges for outpatient setting,1626.8,83,,1301.44,percent of total billed charges,83% of total billed charges for outpatient setting,980,50,,784,percent of total billed charges,50% of total billed charges for outpatient setting,980,50,,784,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,767.69,39.17,,614.152,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,686,1626.8,
SKINSLEEVE - ARM LIGHT TONE LG,90007277,CDM,270,RC,,,outpatient,,,41,20.5,,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.74,38.4,,12.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,14.35,35,,11.48,percent of total billed charges,35% of total billed charges for outpatient setting,31.98,78,,25.584,percent of total billed charges,78% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,28.7,70,,22.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.75,75,,24.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.03,83,,27.224,percent of total billed charges,83% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,20.5,50,,16.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.05,39.17,,12.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,14.35,34.03,
SUTURE - 8622H PROLENE 3-0,90007853,CDM,270,RC,,,outpatient,,,995,497.5,,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,382.08,38.4,,305.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348.25,35,,278.6,percent of total billed charges,35% of total billed charges for outpatient setting,776.1,78,,620.88,percent of total billed charges,78% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,696.5,70,,557.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,746.25,75,,597,percent of total billed charges,75% of total billed charges for outpatient setting,825.85,83,,660.68,percent of total billed charges,83% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,497.5,50,,398,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,389.72,39.17,,311.776,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,348.25,825.85,
SUTURE - VICRYL 4-0 VCP214H,90007855,CDM,270,RC,,,outpatient,,,18,9,,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,6.91,38.4,,5.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,6.3,35,,5.04,percent of total billed charges,35% of total billed charges for outpatient setting,14.04,78,,11.232,percent of total billed charges,78% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,12.6,70,,10.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.5,75,,10.8,percent of total billed charges,75% of total billed charges for outpatient setting,14.94,83,,11.952,percent of total billed charges,83% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,9,50,,7.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.05,39.17,,5.64,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,6.3,14.94,
SUTURE - VICRYL VCP603H 0,90007860,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
SYSTEM - CTR73 12X100MM ACCESS,90007933,CDM,270,RC,,,outpatient,,,1050,525,,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,403.2,38.4,,322.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,403.2,38.4,,322.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,787.5,75,,630,percent of total billed charges,75% of total billed charges for outpatient setting,787.5,75,,630,percent of total billed charges,75% of total billed charges for outpatient setting,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,787.5,75,,630,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,367.5,35,,294,percent of total billed charges,35% of total billed charges for outpatient setting,819,78,,655.2,percent of total billed charges,78% of total billed charges for outpatient setting,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,735,70,,588,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,787.5,75,,630,percent of total billed charges,75% of total billed charges for outpatient setting,871.5,83,,697.2,percent of total billed charges,83% of total billed charges for outpatient setting,525,50,,420,percent of total billed charges,50% of total billed charges for outpatient setting,525,50,,420,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,411.26,39.17,,329.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,367.5,871.5,
TUBE - 10FR SALEM SUMP,90008266,CDM,270,RC,,,outpatient,,,370,185,,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,142.08,38.4,,113.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,142.08,38.4,,113.664,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.5,35,,103.6,percent of total billed charges,35% of total billed charges for outpatient setting,288.6,78,,230.88,percent of total billed charges,78% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,259,70,,207.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.5,75,,222,percent of total billed charges,75% of total billed charges for outpatient setting,307.1,83,,245.68,percent of total billed charges,83% of total billed charges for outpatient setting,185,50,,148,percent of total billed charges,50% of total billed charges for outpatient setting,185,50,,148,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,144.92,39.17,,115.936,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,129.5,307.1,
BLADE - #2 MILLER GRNLINE DISP,90008786,CDM,270,RC,,,outpatient,,,930,465,,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,357.12,38.4,,285.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,357.12,38.4,,285.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,325.5,35,,260.4,percent of total billed charges,35% of total billed charges for outpatient setting,725.4,78,,580.32,percent of total billed charges,78% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,651,70,,520.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,697.5,75,,558,percent of total billed charges,75% of total billed charges for outpatient setting,771.9,83,,617.52,percent of total billed charges,83% of total billed charges for outpatient setting,465,50,,372,percent of total billed charges,50% of total billed charges for outpatient setting,465,50,,372,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,364.26,39.17,,291.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,325.5,771.9,
TUBE - 14FR GASTRO FEED W/Y PR,90009000,CDM,270,RC,,,outpatient,,,108,54,,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,41.47,38.4,,33.176,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.8,35,,30.24,percent of total billed charges,35% of total billed charges for outpatient setting,84.24,78,,67.392,percent of total billed charges,78% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,75.6,70,,60.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81,75,,64.8,percent of total billed charges,75% of total billed charges for outpatient setting,89.64,83,,71.712,percent of total billed charges,83% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,54,50,,43.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,42.3,39.17,,33.84,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,37.8,89.64,
TUBE - 12FR NASOGASTRIC FEEDIN,90009002,CDM,270,RC,,,outpatient,,,46,23,,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,17.66,38.4,,14.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.1,35,,12.88,percent of total billed charges,35% of total billed charges for outpatient setting,35.88,78,,28.704,percent of total billed charges,78% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,32.2,70,,25.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.5,75,,27.6,percent of total billed charges,75% of total billed charges for outpatient setting,38.18,83,,30.544,percent of total billed charges,83% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,23,50,,18.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.01,39.17,,14.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.1,38.18,
TUBE - 24FR 2.0 MIC-KEY LP,90009090,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUTURE - 698H 5-0 ETHILON BLK MONO,90009091,CDM,270,RC,,,outpatient,,,26,13,,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,9.98,38.4,,7.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.1,35,,7.28,percent of total billed charges,35% of total billed charges for outpatient setting,20.28,78,,16.224,percent of total billed charges,78% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,18.2,70,,14.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.5,75,,15.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.58,83,,17.264,percent of total billed charges,83% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,13,50,,10.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.18,39.17,,8.144,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.1,21.58,
TRAY - EPIDURAL,90009095,CDM,270,RC,,,outpatient,,,85,42.5,,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,32.64,38.4,,26.112,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,29.75,35,,23.8,percent of total billed charges,35% of total billed charges for outpatient setting,66.3,78,,53.04,percent of total billed charges,78% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,59.5,70,,47.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63.75,75,,51,percent of total billed charges,75% of total billed charges for outpatient setting,70.55,83,,56.44,percent of total billed charges,83% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,42.5,50,,34,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.29,39.17,,26.632,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,29.75,70.55,
SUTURE - VICRYL 5-0 RB-1 27IN UNDYE,90009239,CDM,270,RC,,,outpatient,,,22,11,,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.45,38.4,,6.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.7,35,,6.16,percent of total billed charges,35% of total billed charges for outpatient setting,17.16,78,,13.728,percent of total billed charges,78% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,15.4,70,,12.32,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.5,75,,13.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.26,83,,14.608,percent of total billed charges,83% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,11,50,,8.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.62,39.17,,6.896,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.7,18.26,
SUTURE - ETHILON 661G 5-0,90009386,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CLIPS - PAGEWRITER TOUCH EKG,90009387,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FEE - CART CUSTOMIZATION,90009388,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
HOLDER - ARMSTRONG SUCTION UNIT,90009389,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SHELF - SIDE SLOW RELEASE,90009390,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
PREMIER IV POLE AND BRACKET,90009391,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CARDIAC BOARD WITH BRACKETS,90009392,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BOX - GLOVE BEIGE,90009393,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
OXYGEN TANK BRACKET,90009394,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
WIRE CHART HOLDER,90009395,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ACCESSORY BRACKET,90009396,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
PLASTIC TOP,90009397,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CRASH CART TRAY W/LID,90009398,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DIVIDER KIT FOR ADT-1 TRAY,90009399,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FULL DRAWER MODULAR TRAY,90009400,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DIVIDER SET FOR 6  DRAWER,90009401,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FOLDER - ELECTRIC BLUE 2POCKET,90009402,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TRUCK/FUEL/TOOL,90009403,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
VALVE - 2W/2P DELTROL SOLENOID,90009404,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TOOL - TOTAL CARE VALVE GUIDE,90009405,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FLUID - HYDRAULIC #36199S,90009406,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CASTER - 5  BRAKE/STEER P1600,90009407,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CASTER - 5  BRAKE P1600,90009409,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BLANKET - COTTON WOVEN BLUE BHG,90009410,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CARD STOCK - LT GREEN 8.5 X 11,90009411,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
MOTOR - CONDENSER FAN DIETARY,90009412,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FILE - ACCORDION WITH FLAP A-Z LETTER SZ,90009413,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
RAIL - WEB SLIDE EXERCISE,90009414,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CLEANER - VIRUSTAT TBQ DISINFECTANT,90009415,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
HEALTH O METER UNIVERSAL WALLMT HT ROD,90009416,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CLIPBOARD - HARDBOARD BROWN,90009417,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ROD - AIREX 30-1910 BALANCE PAD,90009418,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SHEET - PT REHAB CLIENT,90009419,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
WEIGHT -  4LB DELUXE CUFF WRIST/ANKLE,90009420,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DUMBBELL - 1LB VINYL COATED CAST IRON,90009421,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DUMBBELL - 2LB VINYL COATED CAST IRON,90009422,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DUMBBELL - 3LB VINYL COATED CAST IRON,90009423,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DUMBBELL - 4LB VINYL COATED CAST IRON,90009424,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DUMBBELL - 5LB VINYL COATED CAST IRON,90009425,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVER - LINEN CART BLUE 24 X48 X60,90009426,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BED - SURPLUS HOSPITAL,90009427,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
STRETCHER - SURPLUS,90009428,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TABLE - EXAM SURPLUS,90009429,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COMBO - REFRIGERATOR/MICROWAVE,90009430,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SOLARWINDS DAMEWARE REMOTE CONTROL,90009431,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DAMEWARE REMOTE SUPPORT LICENSE,90009432,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TIP - EAR PROBE NATUS 1361-10-US,90009433,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BACKPACK  - COLLECTIONS BLACK 17,90009434,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
LOANER - GIF-Q180 GASTROVIDEOSCOPE,90009435,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
REPAIR - GIF Q180 OLYMPUS,90009436,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TUBING - REUSABLE FLEXIBLE GREY,90009437,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DREAMWEAR EE ELBOW RP,90009438,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BAG - LAUNDRY DRAWSTRING COTTON 36X24,90009439,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
RENTAL  -  LEXMARK M3250/EQ9438 PRIMARY,90009440,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
RENTAL  -  LEXMARK M3250/EQ9650 PRIMARY,90009441,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
RENTAL  -  KYOCERA/M3660IDN PRIMARY,90009442,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
RENTAL  -  LEXMARK /M5255 PRIMARY,90009443,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BAND -  DNR  ALERT WRIST ID,90009444,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
UBIQUITI UNIFI NANOHD WIRELESS,90009445,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
UBIQUITI UNIFI SWITCH US RACK MOUNT,90009446,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
DRESSING - MAXORB EXTRA ALGINATE 4X4,90009656,CDM,270,RC,,,outpatient,,,2040,1020,,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,783.36,38.4,,626.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,783.36,38.4,,626.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,1530,75,,1224,percent of total billed charges,75% of total billed charges for outpatient setting,1530,75,,1224,percent of total billed charges,75% of total billed charges for outpatient setting,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,1530,75,,1224,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,714,35,,571.2,percent of total billed charges,35% of total billed charges for outpatient setting,1591.2,78,,1272.96,percent of total billed charges,78% of total billed charges for outpatient setting,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,1428,70,,1142.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1530,75,,1224,percent of total billed charges,75% of total billed charges for outpatient setting,1693.2,83,,1354.56,percent of total billed charges,83% of total billed charges for outpatient setting,1020,50,,816,percent of total billed charges,50% of total billed charges for outpatient setting,1020,50,,816,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,799.03,39.17,,639.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,714,1693.2,
BANDAGE - 6  COFLEX SELF ADHERENT TAN,90009689,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
DVD DRIVE - EXTERNAL USB 3.0,90009690,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
ANALYZER - I-STAT 1 WIRELESS,90009691,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
BATTERY - I-STAT 1 9V NIMH RECHARGEABLE,90009692,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
INFO HQ EXP MAINTENANCE 7YR,90009693,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
CLIPBOARD - PLASTIC,90009694,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
BAG - CANON -100EG CUSTOM GADGET,90009695,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
MESH - VENTRALIGHT ST 4.5  CIRCLE,90009696,CDM,278,RC,C1781,HCPCS,both,,,2346,1173,,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,900.86,38.4,,720.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,900.86,38.4,,720.688,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,1642.2,70,,1313.76,percent of total billed charges,70% of billed charges for implant carveouts,1876.8,80,,1501.44,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,821.1,35,,656.88,percent of total billed charges,35% of total billed charges for outpatient setting,1829.88,78,,1463.904,percent of total billed charges,78% of total billed charges for outpatient setting,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,1642.2,70,,1313.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1759.5,75,,1407.6,percent of total billed charges,75% of total billed charges for outpatient setting,1947.18,83,,1557.744,percent of total billed charges,83% of total billed charges for outpatient setting,1173,50,,938.4,percent of total billed charges,50% of total billed charges for outpatient setting,1173,50,,938.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,918.88,39.17,,735.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,821.1,1947.18,
MESH - VENTRALIGHT ST 6 X8  ELLIPSE,90009697,CDM,278,RC,C1781,HCPCS,both,,,2985,1492.5,,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1146.24,38.4,,916.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1146.24,38.4,,916.992,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,2089.5,70,,1671.6,percent of total billed charges,70% of billed charges for implant carveouts,2388,80,,1910.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1044.75,35,,835.8,percent of total billed charges,35% of total billed charges for outpatient setting,2328.3,78,,1862.64,percent of total billed charges,78% of total billed charges for outpatient setting,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,2089.5,70,,1671.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2238.75,75,,1791,percent of total billed charges,75% of total billed charges for outpatient setting,2477.55,83,,1982.04,percent of total billed charges,83% of total billed charges for outpatient setting,1492.5,50,,1194,percent of total billed charges,50% of total billed charges for outpatient setting,1492.5,50,,1194,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1169.16,39.17,,935.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1044.75,2477.55,
CREDIT - EXCHANGE,90009698,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
TUBE - PERCUT ENDO GASTRO 24FR PULL,90009746,CDM,270,RC,,,outpatient,,,970,485,,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,372.48,38.4,,297.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,372.48,38.4,,297.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,727.5,75,,582,percent of total billed charges,75% of total billed charges for outpatient setting,727.5,75,,582,percent of total billed charges,75% of total billed charges for outpatient setting,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,727.5,75,,582,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.5,35,,271.6,percent of total billed charges,35% of total billed charges for outpatient setting,756.6,78,,605.28,percent of total billed charges,78% of total billed charges for outpatient setting,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,679,70,,543.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,727.5,75,,582,percent of total billed charges,75% of total billed charges for outpatient setting,805.1,83,,644.08,percent of total billed charges,83% of total billed charges for outpatient setting,485,50,,388,percent of total billed charges,50% of total billed charges for outpatient setting,485,50,,388,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,379.93,39.17,,303.944,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,339.5,805.1,
SUTURE -  VCP270H 2-0 VICRYL 27 IN O,90009815,CDM,270,RC,,,outpatient,,,665,332.5,,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255.36,38.4,,204.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,255.36,38.4,,204.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.75,35,,186.2,percent of total billed charges,35% of total billed charges for outpatient setting,518.7,78,,414.96,percent of total billed charges,78% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,551.95,83,,441.56,percent of total billed charges,83% of total billed charges for outpatient setting,332.5,50,,266,percent of total billed charges,50% of total billed charges for outpatient setting,332.5,50,,266,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,260.47,39.17,,208.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,232.75,551.95,
PAD - LEG HOLDER ROUND DISP,90009863,CDM,270,RC,,,outpatient,,,1555,777.5,,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,597.12,38.4,,477.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,597.12,38.4,,477.696,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,1166.25,75,,933,percent of total billed charges,75% of total billed charges for outpatient setting,1166.25,75,,933,percent of total billed charges,75% of total billed charges for outpatient setting,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,1166.25,75,,933,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,544.25,35,,435.4,percent of total billed charges,35% of total billed charges for outpatient setting,1212.9,78,,970.32,percent of total billed charges,78% of total billed charges for outpatient setting,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,1088.5,70,,870.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1166.25,75,,933,percent of total billed charges,75% of total billed charges for outpatient setting,1290.65,83,,1032.52,percent of total billed charges,83% of total billed charges for outpatient setting,777.5,50,,622,percent of total billed charges,50% of total billed charges for outpatient setting,777.5,50,,622,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,609.06,39.17,,487.248,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,544.25,1290.65,
BAG - LAUNDRY DRAWSTRING COTTON 36 x 24,90010230,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
WIPE - PURELL HAND SANITIZING 270 CT,90010231,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SANITIZER - PURELL ADV HAND  8 OZ PUMP,90010232,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
WIPE - CLOROX DISINFECTING COMMERCIAL,90010233,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
AGREEMENT. -LICENSE SOFTWARE,90010234,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
TRIPP LITE WALLMOUNT RACK 2U RACK BRACKE,90010287,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SPRAY GARD +HEAD PIECE W/REMOV LENS,90010288,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVERALLS - DISPOSABLE 2XL WHITE,90010289,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVERALLS - LARGE DISPOSABLE WHITE,90010290,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVER - XL/2XL DISPOSABLE WHITE SHOE,90010291,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVERALLS X-LARGE DISP WHITE,90010292,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLOVE - SMALL NITRILE PF EXAM,90010293,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLOVE - MEDIUM NITRILE PF/LF EXAM,90010294,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLOVE - LARGE NITRILE PF/LF EXAM,90010295,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLOVE - X-LARGE NITRILE PF/LF EXAM,90010296,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CITRACE - HOSP DISINF AND DEOD SPRAY,90010297,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
WIPE  - CLOROX HYDROGEN PEROXIDE DISINF,90010298,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SPRAY - CLOROX  BLEACH GERM CLEANER,90010299,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BOARD - DRY-ERASE BOARD 8.5 X11 SPARCO,90010301,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
VOYANT 5MM FUSION (5MM X 37CM),90010421,CDM,270,RC,,,outpatient,,,3150,1575,,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1209.6,38.4,,967.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1209.6,38.4,,967.68,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,2362.5,75,,1890,percent of total billed charges,75% of total billed charges for outpatient setting,2362.5,75,,1890,percent of total billed charges,75% of total billed charges for outpatient setting,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,2362.5,75,,1890,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1102.5,35,,882,percent of total billed charges,35% of total billed charges for outpatient setting,2457,78,,1965.6,percent of total billed charges,78% of total billed charges for outpatient setting,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,2205,70,,1764,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2362.5,75,,1890,percent of total billed charges,75% of total billed charges for outpatient setting,2614.5,83,,2091.6,percent of total billed charges,83% of total billed charges for outpatient setting,1575,50,,1260,percent of total billed charges,50% of total billed charges for outpatient setting,1575,50,,1260,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1233.79,39.17,,987.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1102.5,2614.5,
VOYANT MARYLAND FUSION 95MMX37CM),90010422,CDM,270,RC,,,outpatient,,,3768,1884,,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1446.91,38.4,,1157.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1446.91,38.4,,1157.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,2826,75,,2260.8,percent of total billed charges,75% of total billed charges for outpatient setting,2826,75,,2260.8,percent of total billed charges,75% of total billed charges for outpatient setting,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,2826,75,,2260.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1318.8,35,,1055.04,percent of total billed charges,35% of total billed charges for outpatient setting,2939.04,78,,2351.232,percent of total billed charges,78% of total billed charges for outpatient setting,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,2637.6,70,,2110.08,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2826,75,,2260.8,percent of total billed charges,75% of total billed charges for outpatient setting,3127.44,83,,2501.952,percent of total billed charges,83% of total billed charges for outpatient setting,1884,50,,1507.2,percent of total billed charges,50% of total billed charges for outpatient setting,1884,50,,1507.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1475.85,39.17,,1180.68,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1318.8,3127.44,
SPECTRUM SU DVM S3 STERILE,90010648,CDM,270,RC,,,outpatient,,,266,133,,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,102.14,38.4,,81.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,93.1,35,,74.48,percent of total billed charges,35% of total billed charges for outpatient setting,207.48,78,,165.984,percent of total billed charges,78% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,186.2,70,,148.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,199.5,75,,159.6,percent of total billed charges,75% of total billed charges for outpatient setting,220.78,83,,176.624,percent of total billed charges,83% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,133,50,,106.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,104.18,39.17,,83.344,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,93.1,220.78,
SUTURE - PROLENE 3-0 SH NEEDLE,90010686,CDM,270,RC,,,outpatient,,,32,16,,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,12.29,38.4,,9.832,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.2,35,,8.96,percent of total billed charges,35% of total billed charges for outpatient setting,24.96,78,,19.968,percent of total billed charges,78% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,22.4,70,,17.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,24,75,,19.2,percent of total billed charges,75% of total billed charges for outpatient setting,26.56,83,,21.248,percent of total billed charges,83% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,16,50,,12.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.54,39.17,,10.032,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,11.2,26.56,
SUTURE - ETHILON 3-0 BLK PS-2,90010688,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
CARDIOIMMUNE XL LVL 3,90010697,CDM,270,RC,,,outpatient,,,430,215,,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,165.12,38.4,,132.096,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,150.5,35,,120.4,percent of total billed charges,35% of total billed charges for outpatient setting,335.4,78,,268.32,percent of total billed charges,78% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,301,70,,240.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,322.5,75,,258,percent of total billed charges,75% of total billed charges for outpatient setting,356.9,83,,285.52,percent of total billed charges,83% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,215,50,,172,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.42,39.17,,134.736,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,150.5,356.9,
TUBE - 24FR 4.5 MIC-KEY,90010756,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPAIR - SPRINKLER HEADS,90010757,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CAR - D1 EMS,90010758,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ANALYZER - BD VERITOR PLUS,90010759,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BD VERITOR - COVID AG,90010760,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MESH - EPIFIX 4 X4.5,90010958,CDM,278,RC,C1781,HCPCS,both,,,4182,2091,,2927.4,70,,2341.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1605.89,38.4,,1284.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1605.89,38.4,,1284.712,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2927.4,70,,2341.92,percent of total billed charges,70% of billed charges for implant carveouts,2927.4,70,,2341.92,percent of total billed charges,70% of billed charges for implant carveouts,2927.4,70,,2341.92,percent of total billed charges,70% of billed charges for implant carveouts,3345.6,80,,2676.48,percent of total billed charges,80% of billed charges for implant carveouts,3345.6,80,,2676.48,percent of total billed charges,80% of billed charges for implant carveouts,2927.4,70,,2341.92,percent of total billed charges,70% of billed charges for implant carveouts,3345.6,80,,2676.48,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1463.7,35,,1170.96,percent of total billed charges,35% of total billed charges for outpatient setting,3261.96,78,,2609.568,percent of total billed charges,78% of total billed charges for outpatient setting,2927.4,70,,2341.92,percent of total billed charges,70% of total billed charges for outpatient setting,2927.4,70,,2341.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3136.5,75,,2509.2,percent of total billed charges,75% of total billed charges for outpatient setting,3471.06,83,,2776.848,percent of total billed charges,83% of total billed charges for outpatient setting,2091,50,,1672.8,percent of total billed charges,50% of total billed charges for outpatient setting,2091,50,,1672.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1638.01,39.17,,1310.408,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1463.7,3471.06,
TUBE - 24FR 2.5  MIC-KEY GASTROSTOMY,90010987,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBE - 24FR 2.7  MIC-KEY GASTROSTOMY,90010988,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPAIR - OR PUMP,90010989,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FEE - LOANER ACCESS,90010990,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - SURE-VUE SIGN STREP A TEST,90010991,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - 3M 1860 N95,90010992,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRAPE - EXTREMITY SURGICAL - T MEDLINE,90010993,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOUNTS - WALL PHONE PINELAND,90010994,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMPLEMENTATION - PT ACCESS MGMT,90010995,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AZALEA - DIRECT MESSAGING,90010996,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT 2.7MM - ARTHREX,90010997,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT 3.5MM - AR-4160-35,90010998,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO LOCK SS 2.7 X10MM,90010999,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO LOCK SS 2.7 X14MM,90011000,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO LOCK SS 2.7 X16MM,90011001,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO TM SS 3.5X14MM CORT,90011002,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO TM SS 3.5X26MM CORT,90011003,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
T-ROPE K-LESS W/DRV SYN REPR SS,90011004,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT 2.5MM - ARTHREX,90011005,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"LOCK - DISTAL FIBULA PLT,SS,LFT,SH",90011006,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHIN - SUPRABALL,90011007,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BAG - BROWN PAPER LUNCH 11  X 6  X3.5,90011008,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - 8 PC BED IN A BAG  QUEEN DOBBYGRAY,90011009,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRONCHOSCOPE - EEII HIGH DEF DIAGNOSTIC,90011010,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TRADE IN - OLYMPUS VIDEOSCOPE,90011011,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ESR- CHEX PLUS MINI 12X3.0ML LVL 1&2,90011012,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PUTTY - ALLOSYNC DBM 2.5CC,90011062,CDM,270,RC,,,outpatient,,,1973,986.5,,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,757.63,38.4,,606.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,757.63,38.4,,606.104,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,1479.75,75,,1183.8,percent of total billed charges,75% of total billed charges for outpatient setting,1479.75,75,,1183.8,percent of total billed charges,75% of total billed charges for outpatient setting,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,1479.75,75,,1183.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,690.55,35,,552.44,percent of total billed charges,35% of total billed charges for outpatient setting,1538.94,78,,1231.152,percent of total billed charges,78% of total billed charges for outpatient setting,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,1381.1,70,,1104.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1479.75,75,,1183.8,percent of total billed charges,75% of total billed charges for outpatient setting,1637.59,83,,1310.072,percent of total billed charges,83% of total billed charges for outpatient setting,986.5,50,,789.2,percent of total billed charges,50% of total billed charges for outpatient setting,986.5,50,,789.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,772.78,39.17,,618.224,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,690.55,1637.59,
SCREW - LO-PRO SCRW TM SS 10MMCORT,90011080,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO SCRW TMSS 3.5X 12MMCORT,90011081,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO SCRW TMSS 3.5X16MMCORT,90011082,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT - 2.5MM CALIBRATED AR-8916-06,90011083,CDM,270,RC,A4649,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"PLATE - LOCKING STRAIGHT SS,4H",90011084,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - INSTRUMENT USAGE,90011085,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - GRUNDFOS SOMPLETE STACK ASSEMBLY,90011086,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CAN - TRASH 32 GAL GREEN ACE,90011087,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CREDIT RETURN - INSTANT SAVINGS,90011088,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
RETRACTOR - BABY WEITLANER 2X3 PRONG BLU,90011101,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT - 3.5MM,90011118,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO LOCK SS 2.7 X12MM,90011119,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO SCRW TMSS 3.5X 14MMCORT,90011120,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO SCRW TMSS 3.5X 20MMCORT,90011121,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
GUIDE WIRE - TROCAR TIP 1.35MM,90011122,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT - 2.0MM CALIBRATED AR-8943-16,90011123,CDM,270,RC,A4649,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT - 2.5MM  AR-8943-30,90011124,CDM,270,RC,A4649,HCPCS,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"LOCK - DISTAL FIBULA PLT,SS,RT,6H",90011125,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TAX - AIRGAS BULK TANK PROPERTY,90011126,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRAIN - BUSHING # 00328813,90011127,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRAIN - GASKET # 00289464,90011128,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BATTERY - 650 MAH 4.8V EXIT # 7146,90011129,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - WRIST & FOREARM CANVAS RTPD 6 I,90011131,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - WRIST & FOREARM CANVAS LEFT PD,90011132,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - WRIST  CANVAS LEFT PAD 4 IN,90011133,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - WRIST CANVAS RIGHT PAD 4 IN,90011134,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPLACEMENT PUMP/GUAGE ASSEMBLY,90011135,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIPS - VISTALAB PIPETTE,90011136,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIPS - FISHERBRAND SUREONE PIPETTE UNIV,90011137,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - FISHERBRAND VOL  ADJ 1-10ML,90011138,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - FISHERBRAND VOL ADJ 2-20 ML,90011139,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - FISHERBRAND VOL ADJ 1-10 ML,90011140,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REFRIGERATOR/ FREEZER - 21 CU FT W/O ICE,90011141,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUBSCRIPTION - NURSE AIDE/VIP,90011142,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SYRINGE - 3ML LEUR LOCK W/O NEEDLE,90011143,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REFRIGERATOR - WHITE 21 CU.FT.,90011144,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
GUAGE - 0-100 PSI RANGE SS 41/2,90011145,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BOX - PHARMACY PLASTIC UTILITY 9X2X7,90011146,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AN16KNOE - EATON NEMA OPEN 208V COIL,90011147,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOP - O-CEDAR DUAL MICROFIBER SWEEPDUST,90011148,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REFILL - O-CEDAR DUAL ACTION DUST MOP,90011149,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - REEL 4 TEST 4 TH ED COMPLETE,90011150,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PAPERS - SANDERSVILLE GEORGIAN,90011151,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BOX - CONTROL NOA,90011152,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MANUAL - STANDARDS FOR BLOOD BANKS,90011153,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TV - VIZIO D SERIES 32 IN HDTV SMART,90011154,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRACKET - FULL MOTION MONITOR WALLMOUNT,90011155,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NIGHTSTAND - TRADITIONAL WOOD W/1 DRAWER,90011156,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - COMPUTER/IPOD REPAIR TOOLS,90011157,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREEN - NONTOUCH 14.0  FHDIPS LED LCD,90011158,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SEAT BELT - PUSH BUTTON # 108722,90011159,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEEDLE - 25GAX5/8 SAFETY HINGEDHYPO SUB,90011160,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PACS SYSTEM USAGE INCREASE/ADD'L/OFFSITE,90011161,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR FULL FACE MD S&M FRAME.HEAD,90011162,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FORM - FUNCTIONAL ABILITIES SECTION GG,90011163,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BOX - THERMISENSE INTERFACE,90011164,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - INTERLINK SYSTEM SOLUTION 2C6402,90011165,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIMTECH KIM WIPES,90011166,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - FISHERBRAND 10-100ML,90011167,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - FISHERBRAND 100-1000ML,90011168,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MAT - THERAPAK AQUI-PAD BENCHTOP ABSORB,90011169,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LOOP- DISPOSABLE RIGID INOCULATING,90011170,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NUCLEASE FREEWATER,90011171,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIPS - SUREONE FILLERED PIPETTE 100ML,90011172,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIPS - SUREONE FILLERED PIPETTE 1000ML,90011173,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PIPETTE - VISTA LAB MLA 10ML,90011174,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - SHOWER CURTAIN AND RUG,90011175,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET -  8 PC GRAY TOWEL,90011176,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DATA  ACCESS,90011177,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CURTAINS - GRAY BEDROOM BLACKOUT PANEL,90011178,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CURTAIN ROD - 1' BLACK  72 -144,90011179,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ACCESS SARS-COV-2 IGM QC C58959,90011180,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUBSC - SONICWAL ADV GATEWAY SECURITY ST,90011181,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SONICWALL  SUPPORT SVS REINSTATEMNT -PEN,90011182,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUBSC - SONICWALL NETWORK SECURITY MA,90011183,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PEN  - OSAGE METALLIC RETRACT BLUE,90011184,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUMBLER - BLUE DOUBLEWALL ACRYLIC,90011185,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUMBLER - TEAL DOUBLEWALL ACRYLIC,90011186,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SHIPPING DISCOUNT - HEALTH PROMOTIONSNOW,90011187,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET UP CHARGE - HEALTH PROMOTIONS NOW,90011188,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SIGN - LABORATORY BLACK LARGE,90011189,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABEL - BIOHAZARD 5.5  X5.5  STICKERS,90011190,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MATTRESS - QUEEN HEIRLOOM N BOXSPRING,90011191,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
STEAMER - BISSELL POWER HEAVY DUTY 3N1,90011192,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCANNER - 2D BARCODE W/ USB CABLE,90011193,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HOLDER - BADGE VERTICAL ACCESS CARD,90011194,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SENSOR - PULSE OXIMETER FINGER MEDIUM 1M,90011195,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
COVER - EQUIPMENT LG CLEAR PLASTIC,90011196,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ADAPTER - ZASLUKE HDMITO VGA CONVERTER,90011197,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TRINITY T650C - CREDIT CARD TERMINAL,90011198,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEATER - FAN FORCED ELECTRIC CEILING PAN,90011199,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPAIR - 5 DIFFERENT LEAK IN CRAWL SPACE,90011200,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DX SWIVELOCK SL 3.5X8.5MM W/FORK EYELET,90011312,CDM,278,RC,C1713,HCPCS,both,,,2127,1063.5,,1488.9,70,,1191.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,816.77,38.4,,653.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,816.77,38.4,,653.416,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1488.9,70,,1191.12,percent of total billed charges,70% of billed charges for implant carveouts,1488.9,70,,1191.12,percent of total billed charges,70% of billed charges for implant carveouts,1488.9,70,,1191.12,percent of total billed charges,70% of billed charges for implant carveouts,1701.6,80,,1361.28,percent of total billed charges,80% of billed charges for implant carveouts,1701.6,80,,1361.28,percent of total billed charges,80% of billed charges for implant carveouts,1488.9,70,,1191.12,percent of total billed charges,70% of billed charges for implant carveouts,1701.6,80,,1361.28,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,744.45,35,,595.56,percent of total billed charges,35% of total billed charges for outpatient setting,1659.06,78,,1327.248,percent of total billed charges,78% of total billed charges for outpatient setting,1488.9,70,,1191.12,percent of total billed charges,70% of total billed charges for outpatient setting,1488.9,70,,1191.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1595.25,75,,1276.2,percent of total billed charges,75% of total billed charges for outpatient setting,1765.41,83,,1412.328,percent of total billed charges,83% of total billed charges for outpatient setting,1063.5,50,,850.8,percent of total billed charges,50% of total billed charges for outpatient setting,1063.5,50,,850.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,833.11,39.17,,666.488,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,744.45,1765.41,
"LOW THREAD SCRW, SS 4.0X50MMCANN LNG",90011315,CDM,270,RC,C1713,HCPCS,outpatient,,,708,354,,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.8,35,,198.24,percent of total billed charges,35% of total billed charges for outpatient setting,552.24,78,,441.792,percent of total billed charges,78% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,587.64,83,,470.112,percent of total billed charges,83% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.31,39.17,,221.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,247.8,587.64,
MASK - DMWR FULL FACE LG S&M FRAME.HEAD,90011356,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR FULL FACE FITPACK MASK.HEAD,90011357,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR FULL FACE MAGNETIC HDGR CLIP,90011358,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR FITPACK W/HDGR ARMSWHDGR,90011359,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR HEADGEAR W/ARMS HEADGEAR,90011360,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DREAMSTATION 15MM HEATED TUBE TUBING,90011361,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PLATES - HRR COLOR STANDARD ENGLISH VERS,90011363,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUMBLER - EMS CARING STRAW 16-OZ,90011364,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUMBLER - EMS CARING STRAW 16-OZ,90011365,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRACE - WEBLY ZAP ANKLE MEDIUM,90011366,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PILLOW - TRI-CORE CERVICAL,90011367,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PILLOW - TRI-CORE CERVICAL,90011368,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PATIENT RIGHTS LAMINATED 11 X17,90011369,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AIR MOVER - FLOOR FAN W/ HANDLE & WHEEL,90011370,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
INSTALL MMA AH FLOORING SYSTEM W/CBASE,90011371,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LINER - BLUE  HERITAGE HC 40  X48,90011372,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOTOR - AIR COMPRESSOR  5HP,90011373,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BAG - NURSING ASSISTANT,90011374,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PASS ASEPTIC SAMPLING SYSTEM,90011375,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BIOGX SARS-COV-2& RNASEP QC,90011376,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABEL - LAB YELLOW PL,90011377,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABEL - LAB RED 1797PL,90011378,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPRAYER - ULV FOGGER MACHINE,90011379,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - ULNAR DEVIATION SZ D,90011380,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPLINT - ULNAR DEVIATION SZ D,90011381,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLEEVE - COMPRESSION MEDIUM 15-20MMHG,90011382,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TABLET - WATER TREATMENT FOR GX TRAINER,90011383,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
POCKET - BINDER W/ WRITEON TABS,90011384,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
POCKET - BINDER CARDINAL POLY 3-HOLE,90011385,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TE5 INERVE ULTRASOUND SYSTEM W/SCREEN,90011386,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DICOM MPPS ( INCL IN THE TE-T 3TC),90011387,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DICOM QUERY/RETREIVE (IN TE-7 3TC),90011388,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
UMT-400 MOBILE TROLLEY,90011389,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
L9-3S LINEAR ARRAY TRANSDUCER,90011390,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - EPUMP 500ML,90011391,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEAD REST W/ ET SLITS & MEMORY FOAM,90011392,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LINER - RED VINYL REPLACEMENT,90011393,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AU CRP LATEX  R-1  4X30ML  OSR6199,90011394,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FLAT RATE REPAIR FOR MONITOR,90011395,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SYRINGE - 1CC 30GA X 1/2 SAFETY ECLIPSE,90011396,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
STATION - PLUGABLE TRIPLE DISPLAY DOCKIN,90011397,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBING - SUCTION STERILE UNIVERSAL 10',90011411,CDM,270,RC,,,outpatient,,,10,5,,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3.84,38.4,,3.072,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.5,35,,2.8,percent of total billed charges,35% of total billed charges for outpatient setting,7.8,78,,6.24,percent of total billed charges,78% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,7,70,,5.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.5,75,,6,percent of total billed charges,75% of total billed charges for outpatient setting,8.3,83,,6.64,percent of total billed charges,83% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,5,50,,4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3.92,39.17,,3.136,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,3.5,8.3,
ACTIGRAFT SYSTEM,90011526,CDM,270,RC,Q4100,HCPCS,outpatient,,,1446,723,,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,555.26,38.4,,444.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,555.26,38.4,,444.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,1084.5,75,,867.6,percent of total billed charges,75% of total billed charges for outpatient setting,1084.5,75,,867.6,percent of total billed charges,75% of total billed charges for outpatient setting,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,1084.5,75,,867.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,506.1,35,,404.88,percent of total billed charges,35% of total billed charges for outpatient setting,1127.88,78,,902.304,percent of total billed charges,78% of total billed charges for outpatient setting,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,1012.2,70,,809.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1084.5,75,,867.6,percent of total billed charges,75% of total billed charges for outpatient setting,1200.18,83,,960.144,percent of total billed charges,83% of total billed charges for outpatient setting,723,50,,578.4,percent of total billed charges,50% of total billed charges for outpatient setting,723,50,,578.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,566.37,39.17,,453.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,506.1,1200.18,
BLANKET - LB BAIR HUGGER,90011684,CDM,270,RC,,,outpatient,,,112,56,,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,43.01,38.4,,34.408,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,39.2,35,,31.36,percent of total billed charges,35% of total billed charges for outpatient setting,87.36,78,,69.888,percent of total billed charges,78% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,78.4,70,,62.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84,75,,67.2,percent of total billed charges,75% of total billed charges for outpatient setting,92.96,83,,74.368,percent of total billed charges,83% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,56,50,,44.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,43.87,39.17,,35.096,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,39.2,92.96,
CAP - SURGEON TRONEX DISP MULTI SPUN,90011685,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
AGREEMENT - REPROCES OER-PRO SERVICE,90011686,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
AGREEMENT - SERVICE ACCESS 2 IMMUNOASSAY,90011687,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
AGREEMENT - SERVICE AU 680 WITH ISE,90011688,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
AGREEMENT - SERVICE AU 680 WITH ISE,90011689,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
SCREENER - SPOT VISION W/CASE AND CORD,90011690,CDM,270,RC,,,outpatient,,,48,24,,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.43,38.4,,14.744,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,16.8,35,,13.44,percent of total billed charges,35% of total billed charges for outpatient setting,37.44,78,,29.952,percent of total billed charges,78% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,33.6,70,,26.88,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36,75,,28.8,percent of total billed charges,75% of total billed charges for outpatient setting,39.84,83,,31.872,percent of total billed charges,83% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,24,50,,19.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,18.8,39.17,,15.04,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,16.8,39.84,
TRAY - 5FR PICC DUAL LUMEN W/NITINOL WIR,90011694,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
FAUCET - KITCHEN SINK CHR STR 26Y196,90011695,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
GAME COVERAGE,90011696,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
SATURDAY  CLINIC,90011697,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
PAPER - ASTROBRIGHT COLORED PRIMARY ASSO,90011698,CDM,270,RC,,,outpatient,,,425,212.5,,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,163.2,38.4,,130.56,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,148.75,35,,119,percent of total billed charges,35% of total billed charges for outpatient setting,331.5,78,,265.2,percent of total billed charges,78% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,297.5,70,,238,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,318.75,75,,255,percent of total billed charges,75% of total billed charges for outpatient setting,352.75,83,,282.2,percent of total billed charges,83% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,212.5,50,,170,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,166.46,39.17,,133.168,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,148.75,352.75,
MULTIFIRE SCORPION NEEDLE,90011709,CDM,270,RC,,,outpatient,,,1190,595,,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,456.96,38.4,,365.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,456.96,38.4,,365.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,416.5,35,,333.2,percent of total billed charges,35% of total billed charges for outpatient setting,928.2,78,,742.56,percent of total billed charges,78% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,833,70,,666.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,892.5,75,,714,percent of total billed charges,75% of total billed charges for outpatient setting,987.7,83,,790.16,percent of total billed charges,83% of total billed charges for outpatient setting,595,50,,476,percent of total billed charges,50% of total billed charges for outpatient setting,595,50,,476,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,466.1,39.17,,372.88,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,416.5,987.7,
TRIPLEDAM CANNULA,90011713,CDM,270,RC,,,outpatient,,,225,112.5,,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,35,,63,percent of total billed charges,35% of total billed charges for outpatient setting,175.5,78,,140.4,percent of total billed charges,78% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,83,,149.4,percent of total billed charges,83% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.13,39.17,,70.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.75,186.75,
"LO-PRO LOCK SCRW ,SS 2.7 X 14MM",90011781,CDM,270,RC,,,outpatient,,,495,247.5,,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,190.08,38.4,,152.064,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,173.25,35,,138.6,percent of total billed charges,35% of total billed charges for outpatient setting,386.1,78,,308.88,percent of total billed charges,78% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,346.5,70,,277.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,371.25,75,,297,percent of total billed charges,75% of total billed charges for outpatient setting,410.85,83,,328.68,percent of total billed charges,83% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,247.5,50,,198,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,193.88,39.17,,155.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,173.25,410.85,
SUTURE - 0 ETHILON L886T,90011993,CDM,270,RC,,,outpatient,,,35,17.5,,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,13.44,38.4,,10.752,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.25,35,,9.8,percent of total billed charges,35% of total billed charges for outpatient setting,27.3,78,,21.84,percent of total billed charges,78% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,24.5,70,,19.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,26.25,75,,21,percent of total billed charges,75% of total billed charges for outpatient setting,29.05,83,,23.24,percent of total billed charges,83% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,17.5,50,,14,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,13.71,39.17,,10.968,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,12.25,29.05,
SUTURE - 3-0 VICRYL UNDYED VCP423H,90012039,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
SUTURE - 2-0 VICRYL UNDYED VCP443H,90012040,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
SUTURE - 3-0 MONOCRYL PLUS PS-2 MCP497G,90012041,CDM,270,RC,,,outpatient,,,50,25,,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,19.2,38.4,,15.36,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,17.5,35,,14,percent of total billed charges,35% of total billed charges for outpatient setting,39,78,,31.2,percent of total billed charges,78% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,35,70,,28,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.5,75,,30,percent of total billed charges,75% of total billed charges for outpatient setting,41.5,83,,33.2,percent of total billed charges,83% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,25,50,,20,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,19.58,39.17,,15.664,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,17.5,41.5,
KIT - TRIMANO BEACH CHAIR,90012046,CDM,270,RC,,,outpatient,,,525,262.5,,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,201.6,38.4,,161.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,183.75,35,,147,percent of total billed charges,35% of total billed charges for outpatient setting,409.5,78,,327.6,percent of total billed charges,78% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,367.5,70,,294,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,393.75,75,,315,percent of total billed charges,75% of total billed charges for outpatient setting,435.75,83,,348.6,percent of total billed charges,83% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,262.5,50,,210,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,205.63,39.17,,164.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,183.75,435.75,
KIT - CANNULA ADAPTER KIT CANNULAS P1324,90012079,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CANNULA - NASAL ADULT 7'  NO FILTER,90012080,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - DMWR FITPACK W/ HEADGEAR ARMS,90012081,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FRAME - DREAMWISP EE ELBOW,90012082,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SWITCH - 5PORT GIGABIT ETHERNET UNMANA,90012083,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BATTERY - # 1168,90012084,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEAD - HILLROM MOTOR ASSEMBLY,90012085,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPLACE LEAKING HEAD,90012086,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - GJ FEEDING TUBE  0270-22-6.0-45,90012087,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBE - FISHERFINEST SEDIPLAST W/ DILUENT,90012088,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
K - WIRE/GUIDE WIRE 1.35MM  AR - 8943-01,90012113,CDM,270,RC,C1713,HCPCS,outpatient,,,60,30,,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,23.04,38.4,,18.432,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,21,35,,16.8,percent of total billed charges,35% of total billed charges for outpatient setting,46.8,78,,37.44,percent of total billed charges,78% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,42,70,,33.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,45,75,,36,percent of total billed charges,75% of total billed charges for outpatient setting,49.8,83,,39.84,percent of total billed charges,83% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,30,50,,24,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.5,39.17,,18.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,21,49.8,
RIGHT 4 HOLE PLATE,90012114,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO LOCK SS 2.7 X18MM,90012115,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SABLE S1 SHAVEN  # 76096,90012116,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - 3.0 CANCELLOUS  16M,90012117,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
5 HOLE LOCKING DISTAL,90012118,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HOT SURFACE IGNITOR MODULE,90012119,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
3 HOLE RIGHT NARROW,90012120,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - 3.5 CORTICAL 14 MM AR-8835-14,90012121,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
SCREW - 3.5 LOCKING 12MM AR-8935L-12,90012122,CDM,278,RC,,,both,,,645,322.5,,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,35,,180.6,percent of total billed charges,35% of total billed charges for outpatient setting,503.1,78,,402.48,percent of total billed charges,78% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,535.35,83,,428.28,percent of total billed charges,83% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.63,39.17,,202.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.75,535.35,
SCREW -2.4 MM CORTICAL 22MM,90012123,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW -2.4 MM CORTICAL 20MM,90012124,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW -2.4 MM LOCKING 20MM,90012125,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW -2.4 MM LOCKING 18MM,90012126,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CONTAINER - CLEAR PLASTIC W/LID 32 QT,90012127,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CONTAINER - CLEAR PLASTIC W/GRAY LID 20Q,90012128,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"IAQ BULK, BACTERIA ONLY",90012129,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LENOVO THINKBOOK 15G3 ACL 15.6,90012130,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CREAM - ANTIFUNGAL SOOTHE AND COOL,90012131,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ELECTRODE - RED DOT MONITORING W/FOAM,90012132,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VTECH SORT AND DISCOVER DRUM,90012133,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BD POSIFLUSH SALINE .9% 30 X10 PREFILLED,90012134,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUNNY HEALTH &FITNESS SQUAT RACK CAGE,90012135,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUNNY HEALTH &FITNESS SQUAT RACK CAGE,90012136,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ABCOASTER MAX MACHINE,90012137,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CAP BARBELL MULTI PURP ADJ BENCH,90012138,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - 12-LEAD LIMB LEAD STANDARD,90012139,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - 12-LEAD LIMB LEAD LONG,90012140,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAIR - VINYL SEAT AND BACK PNEUMATIC,90012141,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
STRYKER STAIR CHAIRS,90012142,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BOWFLEX TREADCLIMBER,90012143,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPLACE/UPGRADE AUTO DOOR OP SYSTEM,90012144,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MAINTENANCE TREATMENT FOR FUEL,90012145,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BIO TREATMENT FOR FUEL,90012146,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
OFF ROAD DIESEL FUEL,90012147,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
THERMOMETER - ENVIRO-SAFE FREEZER,90012148,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
THERMOMETER - ENVIRO-SAFE BLOOD BANK,90012149,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REFRIGERATOR - PERFORMANCE MED GRADE,90012150,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MATERIAL SURCHARGE,90012151,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WCRMC CHRISTMAS PULLOVERS 2021,90012152,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - 3M 1860S N95,90012153,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAINS -  WOUND CARE CURTAIN,90012154,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CONTAINER - 30GAL CEMT GRAY STORAGE,90012155,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VERTIV LIEBERT GXT5-UPS - 2000VA/1800W,90012156,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CRUSHER - PILL,90012157,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IPAD -  9TH GENERATION,90012158,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CASE - IPAD W/ SCREEN PROTECTOR,90012159,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KEYBOARD - WIRELESS BLUETOOTH IPAD,90012160,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PAPER - PHIZATEST NITRAZINE INDICATOR,90012161,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PASTE - ZINC REMEDY ESSENTIALS SKIN PROT,90012162,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NORDICTRACK COMMSER 1750 TREADMILL,90012163,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TRUCK - MULTI-PURPOSE PLATFORM RM CART,90012164,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FACILITY CLEANING,90012165,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SENSOR - ADULT SPO2 REUSABLE CLIP,90012166,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SENSOR - ADULT SPO2 REUSABLE CLIP,90012167,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CABLE - MULTI-PATIENT 8-PIN -9-PIN SUB A,90012168,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SENSOR - SPO2 SINGLE -PATIENT WRAP,90012169,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CABLE - 5-WIRE ECG LEAD PATIENT SPO2,90012170,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CAP - DISINFECTANT SWAB,90012171,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SIGN - NOTICE LOADING ARE NO PARKING,90012172,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCANNER - SMARTOFFICE PS286 PLUS,90012173,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SIGN - RESERVED PARKING FOR EMPL OF MONT,90012174,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
METAL TOP - 10' X 10' X 6,90012175,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - DRESSING CHANGEW/TEGADERM/BIOPATCH,90012176,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
RJ45 INLINE COUPLER FEMALE TO FEMALE,90012178,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPAIR -  BAXTER IV PUMP FLAT RATE,90012179,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HMD F 3068 4 18 CRS HC S F BASEMENT DOOR,90012180,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAIR - CEO EXECUTIVE OFFICE DESK,90012181,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CASTER 5 STAINLESS STEEL TOTAL LOCK,90012182,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CASTER 5 STAINLESS STEEL DIRECTIONAL LOC,90012183,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CF-HQ190L REFURBISHMENT LEVEL 3,90012184,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
INSPECTION ON GAS TRAIN  & COMBUTION TUN,90012185,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ETAC2 - HEAT PUMP 12000 BTUH 3.5KW,90012186,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DOCKING STATION  - DUAL HDMI LAPTOP,90012187,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VLIEBERT UPS BATTERY CABINET SYSTEM,90012188,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PEN - WACO SURGICAL CENTER BALLPOINT,90012189,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRACE - ANKLE SMALL 7-9 BUNGEE CLOSURE,90012190,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRACE - AMB FOOTDROP LEFT FOOT BLACK,90012191,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
POWER CLIP # 2245-T,90012192,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
GLOVE - OPEN FINGER COMPRESSION LT LG,90012193,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUPPORTS- PADDED FLIPAWAY ARM LEFT,90012194,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOUSE - LOGITECH M317 WIRELESS USB 2.4,90012195,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BRACE - HYPEREXTENSION KNEE MED LEFT,90012196,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEEDLE HOLDER - MAYO HEGAR 5 1/2  SERRAT,90012197,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEEDLE HOLDER - MAYO HEGAR 5   SERRAT,90012198,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BATTERY -  REHAB LAPTOP TG T545FJ 60WH,90012199,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
STAMP - OR  UPDATE TO H &P,90012200,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LANYARD - WELLNESS 5/8   ROYAL BLUEW/CLI,90012201,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ORTHOSES - FULL WRAPAROUND KNEE XL,90012202,CDM,270,RC,,,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
ANNUAL ROUTINE PM AND CERT MICROSCOPES,90012203,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASH BOTTLE - BLEACH WIDE LABEL 16 OZ,90012204,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASH BOTTLE - DEIONIZED WATER 16OZ,90012205,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASH BOTTLE - SALINE SOLUTION 16OZ,90012206,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASH BOTTLE - 70% ETHANOL 16 OZ,90012207,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLING - ARJO LIFT PADDED LARGE,90012208,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLING - ARJO LIFT PADDED X- LARGE,90012209,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLING - ARJO LIFT MESH PADDED  LARGE,90012210,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLING - ARJO LIFT MESH PADDED  X- LARGE,90012211,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TRIPP LITE KEYSPAN USB TO ADAPTER 3FT,90012212,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DELL OPTIPLEX 3080 MICRO,90012213,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PYLOPLUS RAPID UREASE TEST,90012214,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"FUSE - FAST ACTING CLASS T,JJN",90012215,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"FUSE - FAST ACTING CLASS T,JJN SERIES 35",90012216,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"SINGLE SHANK BALL , 303SE/SZ 1/8",90012217,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BURR - OVAL FLUSHCUT 12 FLUTE,90012281,CDM,270,RC,,,outpatient,,,465,232.5,,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,178.56,38.4,,142.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,178.56,38.4,,142.848,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,348.75,75,,279,percent of total billed charges,75% of total billed charges for outpatient setting,348.75,75,,279,percent of total billed charges,75% of total billed charges for outpatient setting,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,348.75,75,,279,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,162.75,35,,130.2,percent of total billed charges,35% of total billed charges for outpatient setting,362.7,78,,290.16,percent of total billed charges,78% of total billed charges for outpatient setting,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,325.5,70,,260.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,348.75,75,,279,percent of total billed charges,75% of total billed charges for outpatient setting,385.95,83,,308.76,percent of total billed charges,83% of total billed charges for outpatient setting,232.5,50,,186,percent of total billed charges,50% of total billed charges for outpatient setting,232.5,50,,186,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,182.13,39.17,,145.704,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,162.75,385.95,
RESTRAINT - HEAD UNIVERSAL DISP,90012282,CDM,270,RC,,,outpatient,,,140,70,,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,53.76,38.4,,43.008,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,49,35,,39.2,percent of total billed charges,35% of total billed charges for outpatient setting,109.2,78,,87.36,percent of total billed charges,78% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,98,70,,78.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,116.2,83,,92.96,percent of total billed charges,83% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,70,50,,56,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,54.84,39.17,,43.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,49,116.2,
DELL OPTIPLEX 3090 -SFF - CORE 15 8GB,90012285,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAIR -  HIGH BACK LEATHER EXECUTIVE,90012286,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SENSOR - ADULT REUSABLE FINGERCLIP SPO2,90012287,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MULTIGUAL ASSAYED LIQ LEVEL I #694,90012288,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MULTIGUAL ASSAYED LIQ LEVEL II # 695,90012289,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MULTIGUAL ASSAYED LIQ LEVEL III #696,90012290,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
RENTAL - TN UNICEL DXH690T,90012291,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AGREEMENT - DXH690T DXS PROTECT SERVICE,90012292,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
EV PHYSICIAN/NURSE TRACKING,90012296,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ERX- INFINED IDENTITY PROOFING,90012297,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BANDAGE - SURE PRESS HIGH COMPRESION,90012298,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FAN - HONEYWELL OUTDOOR CEILING 52 IN,90012299,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PEN -  ECF WHITE/BLUE,90012300,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MAGNET - ECF BUSINESS  CARD,90012301,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMMUNOASSAY PLUS LVL 1   # 361,90012353,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMMUNOASSAY PLUS LVL 2   # 362,90012354,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMMUNOASSAY PLUS LVL 3   # 363,90012355,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ETOH/AMMONIA  LVL 1 #544,90012356,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ETOH/AMMONIA  LVL 1 #546,90012357,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPECIALTY IMMUNOASSAY LEVEL 1 #364,90012358,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SPECIALTY IMMUNOASSAY LEVEL 2 #365,90012359,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CARDIAC MARKERS LEVEL L (LOW) #149,90012360,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CARDIAC MARKERS LEVEL 1 (ONE) # 181,90012361,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CARDIAC MARKERS LEVEL 3 #183,90012362,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PUMP - VACUUM # ACCAT1E-2703-1,90012363,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPAIR - LABOR,90012364,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRYER - BONNET HOOD W/ WHEELS ADJ HEIGHT,90012365,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - CYSTO-BLADDER IRRIGATION 81  /CLAM,90012366,CDM,270,RC,,,outpatient,,,770,385,,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,295.68,38.4,,236.544,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,269.5,35,,215.6,percent of total billed charges,35% of total billed charges for outpatient setting,600.6,78,,480.48,percent of total billed charges,78% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,539,70,,431.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,577.5,75,,462,percent of total billed charges,75% of total billed charges for outpatient setting,639.1,83,,511.28,percent of total billed charges,83% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,385,50,,308,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,301.59,39.17,,241.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,269.5,639.1,
PLAQUE - GEORGE JONES RETIREMENT,90012367,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BLADE - MEDIUM 14MM  AR-300-040S,90012368,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BLADE - NARROW 9.5MM  AR-300-041S,90012369,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BLADE - MEDIUM 9.4MM  AR-300-042S,90012370,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BLADE - NARROW 5.5MM AR-300-044S,90012371,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ASSEMBLY CASTER FRONT,90012372,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CASTER REAR DUAL WHEEL TOTAL LOCK,90012373,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WATCH - GEORGE JONES RETIREMENT GIFT,90012374,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TAPE - WITE -OUT CORRECTION WHITE,90012375,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
REPLACE SURGE PROTECTOR,90012376,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAIR - WORKSPACE BLACK FABRIC OFFICE,90012377,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUPPORT - MESH LUMBAR FOR OFFICE CHAIR,90012378,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRAPE - U-DRAPE BLUE STERILE 60 X84,90012379,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KIT - S/M DREAMWEAR NASAL MASK W/HGR,90012380,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"FRAME - DMWR M FULL MED W/HGR, GBL",90012381,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
STRAP - PREMIUM CHIN  RESPIRONICS,90012382,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FILTER - DS2 DISP ULTRA-FINE 6PK,90012383,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FILTER - DS2 REUSABLE POLLEN,90012384,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH F20 CUSHION LGE,90012385,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH F20 CUSHION MED,90012386,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH F20 CUSHION SML,90012387,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT F20 STD SLM,90012388,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 PILLOW LARGE,90012389,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 PILLOW MEDIUM,90012390,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 PILLOW SMALL,90012391,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SYSTEM - AIRFIT P10 MASK SLM,90012392,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT P10 ADJUSTABLE,90012393,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SYSTEM - AIRFIT P10 MASK AMER,90012394,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SYSTEM - AIRFIT P10 FOR HER  AMER,90012395,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CRUCIAL MX500 250GB 3D 2.5IN SSD,90012396,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PRECISION SCREWDRIVER SET  COMPUTERKIT,90012397,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BATTERY - NEW LENOVO THINKPAD LAPTOP E S,90012398,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
POSITIONER - CHEST ROLL ALIBLUE,90012399,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
OVERLAY - NONSLIP SURFACE 20 W X 46.5  L,90012400,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - VAL KREULOCK TI 2.4 X 18,90012401,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LOW PROFILE 2.4MM X 18MM CORTEX,90012402,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LO-PRO TI 3.5MMX 12MM,90012403,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - LOCKING TITANIUM 3.5MM X 14MM,90012404,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PILLOW - FOOT ELEVATION,90012406,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"SCREW - QUICKFIX TI, CANC PT 3.0 X 20MM",90012407,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"SCREW - QUICKFIX TI, CANC PT 3.0 X 24MM",90012408,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
"SCREW - QUICKFIX TI, CANC PT 3.0 X 26 MM",90012409,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASHER  - 6.5 MM TI  AR-8730W,90012410,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIP - THD GDWIRE W TRCR 045  W/LASER LIN,90012411,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRILL BIT - CANNULATED 2.0MM AR-8933-20C,90012412,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - 2.7 LOCKING  AR- 8827L-16,90012413,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 2.7 LOCKING  AR- 8827L-18,90012414,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 3.5 CORTICOL AR - 8835-16,90012415,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
PLATE - 4 HOLE LOCKING AR-8943DR-04,90012416,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SIMULATOR - QUIK-COMBO 12-LEAD PATIENT,90012417,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SONICWALL ADV GATEWAY SECURITY STESUB,90012418,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SONICWALL NETWORK SECURITY MANAGER,90012419,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYNGOSCOPE,90012420,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BATTERY,90012421,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BLADE SZ 1,90012422,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BLADE SZ 2,90012423,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BLADE SZ 3,90012424,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BLADE SZ 4,90012425,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MCGRATH MAC EMS VIDEO LARYN BLADE SZ X3,90012426,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SET - HEAD AND FOOT BOARD 7010009MAH,90012427,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MAGNET - WCRMC  BUSINESS  CARD,90012429,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHARGER - POWER ADAPTER LATITUDE,90012430,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DRIVE - DELL USB DW316 BLACK,90012431,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CREAM - FIRST AID/ BURN  0.9GM,90012432,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WASHCLOTH - EASICLEANSE NO -RINSE,90012433,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BACKPACK - EMS DOUBLE POCKET,90012434,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TUBE - TRACH 6.0 XLT DISTAL,90012435,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CANNULA - DISP INNER SZ 6,90012436,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PAD - ARMBOARD STANDARD 6INX26INX3IN,90012437,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TIME AND MATERIAL TO REPAIR  A  BANK,90012438,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUTURE ANCHOR BIOCOMPOSILLA AR-2324KBCC,90012500,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
SUTURE ANCHOR PUSHLOCK AR-1926PS,90012502,CDM,270,RC,C1713,HCPCS,outpatient,,,1545,772.5,,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,593.28,38.4,,474.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,593.28,38.4,,474.624,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,1158.75,75,,927,percent of total billed charges,75% of total billed charges for outpatient setting,1158.75,75,,927,percent of total billed charges,75% of total billed charges for outpatient setting,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,1158.75,75,,927,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,540.75,35,,432.6,percent of total billed charges,35% of total billed charges for outpatient setting,1205.1,78,,964.08,percent of total billed charges,78% of total billed charges for outpatient setting,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,1081.5,70,,865.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1158.75,75,,927,percent of total billed charges,75% of total billed charges for outpatient setting,1282.35,83,,1025.88,percent of total billed charges,83% of total billed charges for outpatient setting,772.5,50,,618,percent of total billed charges,50% of total billed charges for outpatient setting,772.5,50,,618,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,605.15,39.17,,484.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,540.75,1282.35,
FIBERTAPE  -   AR-7237-17LN,90012505,CDM,270,RC,,,outpatient,,,500,250,,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,192,38.4,,153.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,192,38.4,,153.6,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,175,35,,140,percent of total billed charges,35% of total billed charges for outpatient setting,390,78,,312,percent of total billed charges,78% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,350,70,,280,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375,75,,300,percent of total billed charges,75% of total billed charges for outpatient setting,415,83,,332,percent of total billed charges,83% of total billed charges for outpatient setting,250,50,,200,percent of total billed charges,50% of total billed charges for outpatient setting,250,50,,200,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,195.84,39.17,,156.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,175,415,
SUTURE - VCP261H,90012529,CDM,270,RC,,,outpatient,,,21,10.5,,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,8.06,38.4,,6.448,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,7.35,35,,5.88,percent of total billed charges,35% of total billed charges for outpatient setting,16.38,78,,13.104,percent of total billed charges,78% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,14.7,70,,11.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,15.75,75,,12.6,percent of total billed charges,75% of total billed charges for outpatient setting,17.43,83,,13.944,percent of total billed charges,83% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,10.5,50,,8.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,8.22,39.17,,6.576,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,7.35,17.43,
PLATE - 6 HOLE LEFT LOCKING AR-8943DL-06,90012533,CDM,278,RC,C1713,HCPCS,both,,,2400,1200,,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,840,35,,672,percent of total billed charges,35% of total billed charges for outpatient setting,1872,78,,1497.6,percent of total billed charges,78% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1800,75,,1440,percent of total billed charges,75% of total billed charges for outpatient setting,1992,83,,1593.6,percent of total billed charges,83% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,940.03,39.17,,752.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,840,1992,
SCREW - 2.7X 14MM LOCKING AR-8827L-14,90012534,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 2.7X 12MM LOCKING AR-8827L-12,90012535,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
PLATE - 3 HOLE STANDARD LEFT,90012536,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW - 2.4 X22MM LOCKING,90012537,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 2.4 X20 MM LOCKING,90012538,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 2.4 X22 MM CORTICAL,90012539,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
SCREW - 2.4 X 24 MM CORTICAL,90012540,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
SCREW - 3.5 X 16 MM  CORTICAL AR 8935-16,90012541,CDM,278,RC,C1713,HCPCS,both,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,180,
SCREW - 3.5 X 14 MM  CORTICAL,90012542,CDM,278,RC,C1713,HCPCS,both,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,180,
SUTURETAPE - AR-7506T,90012543,CDM,270,RC,A4649,HCPCS,outpatient,,,214.5,107.25,,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.08,35,,60.064,percent of total billed charges,35% of total billed charges for outpatient setting,167.31,78,,133.848,percent of total billed charges,78% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,178.04,83,,142.432,percent of total billed charges,83% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.02,39.17,,67.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,75.08,178.04,
PARS QUAD REPAIR SYSTEM,90012544,CDM,278,RC,C1713,HCPCS,both,,,5250,2625,,3675,70,,2940,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2016,38.4,,1612.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2016,38.4,,1612.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,3675,70,,2940,percent of total billed charges,70% of billed charges for implant carveouts,3675,70,,2940,percent of total billed charges,70% of billed charges for implant carveouts,3675,70,,2940,percent of total billed charges,70% of billed charges for implant carveouts,4200,80,,3360,percent of total billed charges,80% of billed charges for implant carveouts,4200,80,,3360,percent of total billed charges,80% of billed charges for implant carveouts,3675,70,,2940,percent of total billed charges,70% of billed charges for implant carveouts,4200,80,,3360,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1837.5,35,,1470,percent of total billed charges,35% of total billed charges for outpatient setting,4095,78,,3276,percent of total billed charges,78% of total billed charges for outpatient setting,3675,70,,2940,percent of total billed charges,70% of total billed charges for outpatient setting,3675,70,,2940,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,3937.5,75,,3150,percent of total billed charges,75% of total billed charges for outpatient setting,4357.5,83,,3486,percent of total billed charges,83% of total billed charges for outpatient setting,2625,50,,2100,percent of total billed charges,50% of total billed charges for outpatient setting,2625,50,,2100,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2056.32,39.17,,1645.056,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1837.5,4357.5,
DX DISPOSABLE KIT - AR -8978DS-01,90012545,CDM,278,RC,C1713,HCPCS,both,,,1377,688.5,,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,528.77,38.4,,423.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,528.77,38.4,,423.016,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,963.9,70,,771.12,percent of total billed charges,70% of billed charges for implant carveouts,963.9,70,,771.12,percent of total billed charges,70% of billed charges for implant carveouts,963.9,70,,771.12,percent of total billed charges,70% of billed charges for implant carveouts,1101.6,80,,881.28,percent of total billed charges,80% of billed charges for implant carveouts,1101.6,80,,881.28,percent of total billed charges,80% of billed charges for implant carveouts,963.9,70,,771.12,percent of total billed charges,70% of billed charges for implant carveouts,1101.6,80,,881.28,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,481.95,35,,385.56,percent of total billed charges,35% of total billed charges for outpatient setting,1074.06,78,,859.248,percent of total billed charges,78% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,963.9,70,,771.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1032.75,75,,826.2,percent of total billed charges,75% of total billed charges for outpatient setting,1142.91,83,,914.328,percent of total billed charges,83% of total billed charges for outpatient setting,688.5,50,,550.8,percent of total billed charges,50% of total billed charges for outpatient setting,688.5,50,,550.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,539.35,39.17,,431.48,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,481.95,1142.91,
IMPLANT SYSTEM SECONDARY FIXATION,90012546,CDM,278,RC,C1713,HCPCS,both,,,3108,1554,,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1193.47,38.4,,954.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1193.47,38.4,,954.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1087.8,35,,870.24,percent of total billed charges,35% of total billed charges for outpatient setting,2424.24,78,,1939.392,percent of total billed charges,78% of total billed charges for outpatient setting,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2331,75,,1864.8,percent of total billed charges,75% of total billed charges for outpatient setting,2579.64,83,,2063.712,percent of total billed charges,83% of total billed charges for outpatient setting,1554,50,,1243.2,percent of total billed charges,50% of total billed charges for outpatient setting,1554,50,,1243.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1217.34,39.17,,973.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1087.8,2579.64,
NEEDLE - SURG MAYO 1/2 CIRCLE 1824-5DC,90012547,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEEDLE - SURG MAYO 1/2 CIRCLE 1824-3DC,90012548,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
NEEDLE - SURG MAYO TAPER POINT 1824-4DC,90012549,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - 4.0 X 36MM CORTICAL AR-8740-36PT,90012583,CDM,278,RC,,,both,,,708,354,,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495.6,70,,396.48,percent of total billed charges,70% of billed charges for implant carveouts,495.6,70,,396.48,percent of total billed charges,70% of billed charges for implant carveouts,495.6,70,,396.48,percent of total billed charges,70% of billed charges for implant carveouts,566.4,80,,453.12,percent of total billed charges,80% of billed charges for implant carveouts,566.4,80,,453.12,percent of total billed charges,80% of billed charges for implant carveouts,495.6,70,,396.48,percent of total billed charges,70% of billed charges for implant carveouts,566.4,80,,453.12,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.8,35,,198.24,percent of total billed charges,35% of total billed charges for outpatient setting,552.24,78,,441.792,percent of total billed charges,78% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,587.64,83,,470.112,percent of total billed charges,83% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.31,39.17,,221.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,247.8,587.64,
WASHER - 7MM  AR-8740W,90012584,CDM,278,RC,,,both,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150,70,,120,percent of total billed charges,70% of total billed charges for outpatient setting,150,70,,120,percent of total billed charges,70% of total billed charges for outpatient setting,150,70,,120,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,150,70,,120,percent of total billed charges,70% of total billed charges for outpatient setting,150,75,,120,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,150,
K-WIRE  AR-8943-01,90012585,CDM,278,RC,,,both,,,87,43.5,,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,33.41,38.4,,26.728,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,87,70,,69.6,percent of total billed charges,70% of total billed charges for outpatient setting,87,70,,69.6,percent of total billed charges,70% of total billed charges for outpatient setting,87,70,,69.6,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,87,70,,69.6,percent of total billed charges,70% of total billed charges for outpatient setting,87,75,,69.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,30.45,35,,24.36,percent of total billed charges,35% of total billed charges for outpatient setting,67.86,78,,54.288,percent of total billed charges,78% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,60.9,70,,48.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,65.25,75,,52.2,percent of total billed charges,75% of total billed charges for outpatient setting,72.21,83,,57.768,percent of total billed charges,83% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,43.5,50,,34.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,34.08,39.17,,27.264,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,30.45,87,
DRILLBIT- 2.6MM  AR-8943-02,90012586,CDM,278,RC,,,both,,,750,375,,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,288,38.4,,230.4,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,525,70,,420,percent of total billed charges,70% of billed charges for implant carveouts,600,80,,480,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,35,,210,percent of total billed charges,35% of total billed charges for outpatient setting,585,78,,468,percent of total billed charges,78% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,525,70,,420,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,562.5,75,,450,percent of total billed charges,75% of total billed charges for outpatient setting,622.5,83,,498,percent of total billed charges,83% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,375,50,,300,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,293.76,39.17,,235.008,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,262.5,622.5,
PENCIL - NEPTUNE SMOKE EVACUATION,90012653,CDM,270,RC,,,outpatient,,,210,105,,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,80.64,38.4,,64.512,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,73.5,35,,58.8,percent of total billed charges,35% of total billed charges for outpatient setting,163.8,78,,131.04,percent of total billed charges,78% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,147,70,,117.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,157.5,75,,126,percent of total billed charges,75% of total billed charges for outpatient setting,174.3,83,,139.44,percent of total billed charges,83% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,105,50,,84,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.25,39.17,,65.8,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,73.5,174.3,
ADHESIVE FELT PREMIUM GRADE,90012654,CDM,270,RC,,,outpatient,,,690,345,,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,264.96,38.4,,211.968,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,241.5,35,,193.2,percent of total billed charges,35% of total billed charges for outpatient setting,538.2,78,,430.56,percent of total billed charges,78% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,483,70,,386.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,517.5,75,,414,percent of total billed charges,75% of total billed charges for outpatient setting,572.7,83,,458.16,percent of total billed charges,83% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,345,50,,276,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,270.26,39.17,,216.208,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,241.5,572.7,
SCREW - 3.5X30 HEADLESS COMPRESSION FT,90012687,CDM,270,RC,,,outpatient,,,1500,750,,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,576,38.4,,460.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,576,38.4,,460.8,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,1125,75,,900,percent of total billed charges,75% of total billed charges for outpatient setting,1125,75,,900,percent of total billed charges,75% of total billed charges for outpatient setting,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,1125,75,,900,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,525,35,,420,percent of total billed charges,35% of total billed charges for outpatient setting,1170,78,,936,percent of total billed charges,78% of total billed charges for outpatient setting,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,1050,70,,840,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1125,75,,900,percent of total billed charges,75% of total billed charges for outpatient setting,1245,83,,996,percent of total billed charges,83% of total billed charges for outpatient setting,750,50,,600,percent of total billed charges,50% of total billed charges for outpatient setting,750,50,,600,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,587.52,39.17,,470.016,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,525,1245,
DRILL BIT - 3.2MM AR-8737-50,90012688,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
DRIVER - T10 HEXALOBE AR-8737-38,90012689,CDM,270,RC,,,outpatient,,,1074,537,,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,412.42,38.4,,329.936,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,375.9,35,,300.72,percent of total billed charges,35% of total billed charges for outpatient setting,837.72,78,,670.176,percent of total billed charges,78% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,751.8,70,,601.44,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,805.5,75,,644.4,percent of total billed charges,75% of total billed charges for outpatient setting,891.42,83,,713.136,percent of total billed charges,83% of total billed charges for outpatient setting,537,50,,429.6,percent of total billed charges,50% of total billed charges for outpatient setting,537,50,,429.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,420.67,39.17,,336.536,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,375.9,891.42,
PROFILE DRILL BIT  - AR-8737-47,90012690,CDM,270,RC,,,outpatient,,,645,322.5,,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,35,,180.6,percent of total billed charges,35% of total billed charges for outpatient setting,503.1,78,,402.48,percent of total billed charges,78% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,535.35,83,,428.28,percent of total billed charges,83% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.63,39.17,,202.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.75,535.35,
GUIDEWIRE - .045MM AR-8737-41,90012691,CDM,270,RC,,,outpatient,,,95,47.5,,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.25,35,,26.6,percent of total billed charges,35% of total billed charges for outpatient setting,74.1,78,,59.28,percent of total billed charges,78% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,78.85,83,,63.08,percent of total billed charges,83% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.21,39.17,,29.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.25,78.85,
RETRACTOR - HEISS ANGLED BLUNT SS 4,90012692,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
D-DIMER INNOVANCE REAGENT,90012693,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
D-DIMER INNOVANCE CONTROL,90012694,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
OWRENS VERONAL BUFFER 1,90012695,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
HOPKINS MEDICAL PRODUCTS BAG,90012696,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
"SIGN INSERT FOR BROOKE COBB,FNP",90012697,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
KIT - CADWELL DISP HSAT APNEA TRK CORE,90012698,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
DESK - L-SHAPE CORNER CLASSIC CHERRY,90012699,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
HIBICLENS - PREP SOLUTION 8 OZ,90012700,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
PRINTER - ZEBRA GK420D DESKTOP,90012701,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
TOW -  HOSPITAL TRUCK,90012702,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
3M TWISTN'FILL DISPENSERS WALL MOUNT,90012703,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
BIOPATCH BLUE 3/4 DISK W/1.55 TEMP CONTR,90012704,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
VERTIV LIEBERT ITAS UPS RACKMOUNT/TOWER,90012705,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
BRUSH - GEMINI DOUBLE-ENDED CHANNEL,90012706,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
REPLACEMENT BATTERY KIT FOR AMX-4+,90012707,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
TP LINK 1000MBPS GIGABIT ETHERNET,90012708,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
SIIG ADAPTER DUAL PROFILE BRACKET,90012709,CDM,270,RC,,,outpatient,,,837,418.5,,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,321.41,38.4,,257.128,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,292.95,35,,234.36,percent of total billed charges,35% of total billed charges for outpatient setting,652.86,78,,522.288,percent of total billed charges,78% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,585.9,70,,468.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,627.75,75,,502.2,percent of total billed charges,75% of total billed charges for outpatient setting,694.71,83,,555.768,percent of total billed charges,83% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,418.5,50,,334.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,327.84,39.17,,262.272,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,292.95,694.71,
TUBE - 22FR MIC-KEY G-J TUBE 6.0CM,90012745,CDM,270,RC,B4087,HCPCS,outpatient,,,975,487.5,,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,31.49,130,,,fee schedule,130% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,760.5,78,,608.4,percent of total billed charges,78% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,682.5,70,,546,percent of total billed charges,70% of total billed charges for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,731.25,75,,585,percent of total billed charges,75% of total billed charges for outpatient setting,809.25,83,,647.4,percent of total billed charges,83% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,487.5,50,,390,percent of total billed charges,50% of total billed charges for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,31.49,100,,,fee schedule,100% CMS Medicare OPPS fee schedule for outpatient setting,31.49,809.25,
SCREW - 4.0X50 MM CANN LONG THREAD,90012756,CDM,270,RC,,,outpatient,,,95,47.5,,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,36.48,38.4,,29.184,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,33.25,35,,26.6,percent of total billed charges,35% of total billed charges for outpatient setting,74.1,78,,59.28,percent of total billed charges,78% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,66.5,70,,53.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,71.25,75,,57,percent of total billed charges,75% of total billed charges for outpatient setting,78.85,83,,63.08,percent of total billed charges,83% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,47.5,50,,38,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,37.21,39.17,,29.768,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,33.25,78.85,
DISSECTOR - 3.0MM SMALL JOINT AR-7300DS,90012757,CDM,270,RC,,,outpatient,,,665,332.5,,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,255.36,38.4,,204.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,255.36,38.4,,204.288,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,232.75,35,,186.2,percent of total billed charges,35% of total billed charges for outpatient setting,518.7,78,,414.96,percent of total billed charges,78% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,465.5,70,,372.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,498.75,75,,399,percent of total billed charges,75% of total billed charges for outpatient setting,551.95,83,,441.56,percent of total billed charges,83% of total billed charges for outpatient setting,332.5,50,,266,percent of total billed charges,50% of total billed charges for outpatient setting,332.5,50,,266,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,260.47,39.17,,208.376,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,232.75,551.95,
PLATE -  5 HOLE MEDIAL HOOK AR-8943H-05,90012758,CDM,270,RC,C1713,HCPCS,outpatient,,,3537,1768.5,,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1358.21,38.4,,1086.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1358.21,38.4,,1086.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1237.95,35,,990.36,percent of total billed charges,35% of total billed charges for outpatient setting,2758.86,78,,2207.088,percent of total billed charges,78% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2935.71,83,,2348.568,percent of total billed charges,83% of total billed charges for outpatient setting,1768.5,50,,1414.8,percent of total billed charges,50% of total billed charges for outpatient setting,1768.5,50,,1414.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1385.37,39.17,,1108.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1237.95,2935.71,
SCREW - 3.5 X 30MM CORTICAL  AR-8835-30,90012759,CDM,270,RC,C1713,HCPCS,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
SCREW - 3.5 X 35MM CORTICAL  AR-8835-35,90012760,CDM,270,RC,C1713,HCPCS,outpatient,,,150,75,,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,57.6,38.4,,46.08,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,52.5,35,,42,percent of total billed charges,35% of total billed charges for outpatient setting,117,78,,93.6,percent of total billed charges,78% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,112.5,75,,90,percent of total billed charges,75% of total billed charges for outpatient setting,124.5,83,,99.6,percent of total billed charges,83% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,75,50,,60,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,58.75,39.17,,47,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,52.5,124.5,
SCREW - 4.0 X 30MM CANNULATED,90012761,CDM,270,RC,C1713,HCPCS,outpatient,,,708,354,,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,271.87,38.4,,217.496,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.8,35,,198.24,percent of total billed charges,35% of total billed charges for outpatient setting,552.24,78,,441.792,percent of total billed charges,78% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,495.6,70,,396.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,531,75,,424.8,percent of total billed charges,75% of total billed charges for outpatient setting,587.64,83,,470.112,percent of total billed charges,83% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,354,50,,283.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,277.31,39.17,,221.848,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,247.8,587.64,
GRASPING FORCEPS INSERT DOUACTION 5 X 36,90012762,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AVANOS MEDICAL CLO TEST,90012763,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AVANOS MEDICAL HYH JACK BEAN UREASE CTL,90012764,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMPLANT SYSTEM - HAND/WRIST AUG REPAIR,90012765,CDM,270,RC,C1713,HCPCS,outpatient,,,6408,3204,,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2460.67,38.4,,1968.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2460.67,38.4,,1968.536,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,4806,75,,3844.8,percent of total billed charges,75% of total billed charges for outpatient setting,4806,75,,3844.8,percent of total billed charges,75% of total billed charges for outpatient setting,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,4806,75,,3844.8,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2242.8,35,,1794.24,percent of total billed charges,35% of total billed charges for outpatient setting,4998.24,78,,3998.592,percent of total billed charges,78% of total billed charges for outpatient setting,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,4485.6,70,,3588.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,4806,75,,3844.8,percent of total billed charges,75% of total billed charges for outpatient setting,5318.64,83,,4254.912,percent of total billed charges,83% of total billed charges for outpatient setting,3204,50,,2563.2,percent of total billed charges,50% of total billed charges for outpatient setting,3204,50,,2563.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2509.88,39.17,,2007.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2242.8,5318.64,
SURGIFLO THROMBIN,90012842,CDM,270,RC,,,outpatient,,,1695,847.5,,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,650.88,38.4,,520.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,650.88,38.4,,520.704,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,1271.25,75,,1017,percent of total billed charges,75% of total billed charges for outpatient setting,1271.25,75,,1017,percent of total billed charges,75% of total billed charges for outpatient setting,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,1271.25,75,,1017,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,593.25,35,,474.6,percent of total billed charges,35% of total billed charges for outpatient setting,1322.1,78,,1057.68,percent of total billed charges,78% of total billed charges for outpatient setting,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,1186.5,70,,949.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1271.25,75,,1017,percent of total billed charges,75% of total billed charges for outpatient setting,1406.85,83,,1125.48,percent of total billed charges,83% of total billed charges for outpatient setting,847.5,50,,678,percent of total billed charges,50% of total billed charges for outpatient setting,847.5,50,,678,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.9,39.17,,531.12,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,593.25,1406.85,
4.75 BC LOOP N TACK TENODESIS IMPL SYSTE,90012903,CDM,270,RC,C1713,HCPCS,outpatient,,,3429,1714.5,,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1316.74,38.4,,1053.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1316.74,38.4,,1053.392,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,2571.75,75,,2057.4,percent of total billed charges,75% of total billed charges for outpatient setting,2571.75,75,,2057.4,percent of total billed charges,75% of total billed charges for outpatient setting,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,2571.75,75,,2057.4,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1200.15,35,,960.12,percent of total billed charges,35% of total billed charges for outpatient setting,2674.62,78,,2139.696,percent of total billed charges,78% of total billed charges for outpatient setting,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,2400.3,70,,1920.24,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2571.75,75,,2057.4,percent of total billed charges,75% of total billed charges for outpatient setting,2846.07,83,,2276.856,percent of total billed charges,83% of total billed charges for outpatient setting,1714.5,50,,1371.6,percent of total billed charges,50% of total billed charges for outpatient setting,1714.5,50,,1371.6,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1343.07,39.17,,1074.456,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1200.15,2846.07,
DIGITAL REFRACTOMETER,90012904,CDM,270,RC,,,outpatient,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
HEAD MOTOR PART# 4040100,90012907,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LICENSE - MS WINDOW SERVER 2022 STD 16C,90012908,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HOOK - CURTAIN NYLO WHEELS AND AXLE,90012909,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABOR FOR TROUBLE ON FIREALARM PANEL,90012910,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FACMOGU DC 12V 3A POWER ADAPTER,90012911,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F30 COMPLETE SYSTEM,90012914,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRSENSE 10 AUTOSET NA C2C CO,90012915,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 LGE - AMER,90012916,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 MED- AMER,90012917,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 SML - AMER,90012918,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 LGE SYS - AMER,90012919,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 MED SYS - AMER,90012920,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 SML SYS - AMER,90012921,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 LGE SYS - AMER,90012922,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 MED SYS - AMER,90012923,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 SML SYS - AMER,90012924,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AIRVIEW - MONITORING LT PREPAID C2C,90012926,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DEVICE SURCHARGE,90012927,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 LGE SYS - SLM,90012928,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 MED SYS - SLM,90012929,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 SML SYS - SLM,90012930,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 LGE SYS - SLM,90012931,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 MED SYS - SLM,90012932,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 CUSHION LGE,90012933,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 CUSHION MED,90012934,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F20 CUSHION SML,90012935,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 CUSHION LGE,90012936,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 CUSHION MED,90012937,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 CUSHION SML,90012938,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT N20 CUSHION LGE,90012939,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 CUSHION MED,90012940,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRTOUCH N20 CUSHION SML,90012941,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT N20 STD - SLM,90012942,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT N20 LGE - SLM,90012943,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT F20 STD - SLM,90012944,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - AIRFIT F20 LGE - SLM,90012945,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SCREW - 3.5 LOCKING 14MM AR-8935L-14,90013047,CDM,278,RC,,,both,,,645,322.5,,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,35,,180.6,percent of total billed charges,35% of total billed charges for outpatient setting,503.1,78,,402.48,percent of total billed charges,78% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,535.35,83,,428.28,percent of total billed charges,83% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.63,39.17,,202.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.75,535.35,
SCREW - 2.4 X 18MM LOCKING,90013048,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
SCREW - 2.4 X 16MM LOCKING,90013049,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
5.0K175MM PIN - AR-8964-03,90013050,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
6.0MK300MM  TRANSFER - AR-8964-06,90013051,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
LARGE COMBO CLAMP - AR-8964-07,90013052,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
400MM CARBON PIN - AR-8964R-400,90013053,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
300MM CARBON PIN - AR-8964R-300,90013054,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
END CAP - AR-8964-22,90013055,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
JUMPSTART 2  X 5  - 120205-10,90013056,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
CLIP  - NOSE BLEED STOPPER,90013130,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ORTHOSIS - DEVIATION HAND/THUMB,90013131,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KEY - REPLACEMENT FOR KEY AR600KEY,90013132,CDM,278,RC,C1713,HCPCS,both,,,2400,1200,,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,840,35,,672,percent of total billed charges,35% of total billed charges for outpatient setting,1872,78,,1497.6,percent of total billed charges,78% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1800,75,,1440,percent of total billed charges,75% of total billed charges for outpatient setting,1992,83,,1593.6,percent of total billed charges,83% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,940.03,39.17,,752.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,840,1992,
PLATE - 5 HOLE AR-8943DL-05,90013133,CDM,278,RC,C1713,HCPCS,both,,,2400,1200,,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,921.6,38.4,,737.28,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,1680,70,,1344,percent of total billed charges,70% of billed charges for implant carveouts,1920,80,,1536,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,840,35,,672,percent of total billed charges,35% of total billed charges for outpatient setting,1872,78,,1497.6,percent of total billed charges,78% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,1680,70,,1344,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1800,75,,1440,percent of total billed charges,75% of total billed charges for outpatient setting,1992,83,,1593.6,percent of total billed charges,83% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,1200,50,,960,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,940.03,39.17,,752.024,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,840,1992,
SCREW - 2.7 X 16 LOCKING  AR- 8827CL-16,90013135,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 2.7 X 18 LOCKING  AR- 8827CL-18,90013136,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 2.7 X 12 LOCKING  AR- 8827CL-12,90013137,CDM,278,RC,C1713,HCPCS,both,,,345,172.5,,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,132.48,38.4,,105.984,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,345,70,,276,percent of total billed charges,70% of total billed charges for outpatient setting,345,75,,276,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,120.75,35,,96.6,percent of total billed charges,35% of total billed charges for outpatient setting,269.1,78,,215.28,percent of total billed charges,78% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,241.5,70,,193.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,258.75,75,,207,percent of total billed charges,75% of total billed charges for outpatient setting,286.35,83,,229.08,percent of total billed charges,83% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,172.5,50,,138,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135.13,39.17,,108.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,120.75,345,
SCREW - 3.5 CORTICOL AR - 8835-12,90013138,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
HARTMANN BONE RONGEUR,90013139,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
BEYER RONGEUR CURVED FORCEPS,90013140,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
TRAY -  LETTER ORGANIZER DESK,90013141,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
BD VACUTAINER TUBE HOLDER,90013142,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
BD 368607 21G VACUTAINER NEEDLE,90013143,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
LAB COAT - 2XL WHITE DISPOSABLE,90013144,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
BINDER - 2   RED 3 RING,90013145,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
MANOMETER - B-SMART FOR PRESSURE MON,90013146,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
BAG - RESPONDER ROYAL BLUE,90013147,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
AASM ANNUAL FACILITY MEMBERSHIP,90013148,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
FLOWMETER - TIMETER SUREGRIP OXYGEN,90013149,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
TIGERLOOP - AR-7534T,90013186,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SYSTEM - SMOOTHBORE BILEVEL BREATHING 22,90013187,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - RN VERTICAL CUSTOM BLUE,90013188,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - LPN VERTICAL CUSTOM GREEN,90013189,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - CNA VERTICAL CUSTOM ORANGE,90013190,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY -  ER TECH VERTICAL CUS BLK,90013191,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY -  DOCTOR VERTICAL CUS RED,90013192,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SERVICE CALL TO YOUR PREMISES,90013193,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SERVICE ADD OF EQUIPMENT TAXABLE,90013194,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SERVICE ADD ON OF EQUIPMENT LABOR,90013195,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
MASK - AIRFIT P10 FOR HER SYS - SLM,90013206,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 ADJUSTABLE HEADGEAR,90013207,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 FOR HER ADJUSTABLE HG,90013208,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 PILLOW X-SMALL,90013209,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F30 CUSHION MED,90013210,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F30 CUSHION SML,90013211,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SLIMLINE TUBING,90013212,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRCURVE 10 VAUTO USA C2C CO,90013213,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 FOR HER SYS - AMER,90013214,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FILTER - S9/FILTER STD 50PACK,90013215,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FORM - CAAP-2 PHONOLOGICAL PROCESS EVAL,90013216,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOBILE CT EXTENSION THROUGH 2/13/23,90013217,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHAIR -  HIGH BACK MESH ERGO  DRAFTING,90013251,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEMOCUE AMERICA HB 201+ ANALYZER,90013252,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
RISER - COMPUTER MONITOR FREE- STAND DES,90013253,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DOCKING STATION - LENOVO THINKPAD,90013254,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KEYBOARD/MOUSE,90013255,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BLUETOOTH ADAPTER,90013256,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CHARGE - UPS RETURN LABEL,90013257,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TV - TCL 32  CLASS720P HD LED ROKU SMART,90013258,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABOR - ACE TECHNOLOGIES,90013259,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
POUCHES - STAPLES THERMAL LETTER,90013261,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LABOR - EMC SECURITY,90013262,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CELLULAR NETWORK COMMUNICATION  - EMC SE,90013263,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
INTERACTIVE SERVICE  - EMC SECURITY,90013264,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DAILY RENTAL - RYLAND ENVIRONMENTAL,90013265,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DISPOSAL CHARGE - RYLAND ENVIRONMENTAL,90013266,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HAUL  CHARGE - ROLL OFF,90013267,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ARM TRAY SECURE TO ARM REST LEFT UPPER E,90013268,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WCRMC CIP RENOVATION PROJECT,90013269,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
TELEMED OPERATING FEE NOV 22-FEB 23,90013270,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
IMPLANT SYSTEM INTERBRCE LIG AUGM REPAIR,90013311,CDM,278,RC,C1713,HCPCS,both,,,3108,1554,,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1193.47,38.4,,954.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1193.47,38.4,,954.776,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,2175.6,70,,1740.48,percent of total billed charges,70% of billed charges for implant carveouts,2486.4,80,,1989.12,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1087.8,35,,870.24,percent of total billed charges,35% of total billed charges for outpatient setting,2424.24,78,,1939.392,percent of total billed charges,78% of total billed charges for outpatient setting,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,2175.6,70,,1740.48,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2331,75,,1864.8,percent of total billed charges,75% of total billed charges for outpatient setting,2579.64,83,,2063.712,percent of total billed charges,83% of total billed charges for outpatient setting,1554,50,,1243.2,percent of total billed charges,50% of total billed charges for outpatient setting,1554,50,,1243.2,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1217.34,39.17,,973.872,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1087.8,2579.64,
SUTURE ANCHOR BIOCOMPOSITE SUTURE TAB,90013312,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
2.4 DISPOSABLE BIT - AR-1322DSC,90013313,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
DISPOSABLE KIT - AR-8478DS-01,90013314,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
K-WIRE - AR- 8741-14,90013315,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
3.5 X54 BEVELED FT SCREW,90013316,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
PROFILE DRILL - AR-8741-36S,90013317,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
4-0 FIBERWIRE  - AR-7228,90013318,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
3.5 X 18MM COMP FT SCREW,90013319,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
CARDS - ACLS,90013320,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
SERVER ENDPONT BACKUP,90013321,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
RUBBERMAID COMMERCIAL SPRING,90013322,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
3' X 4' CHARCOAL FLOOR MATS,90013323,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
INSERT  BABCOCK GRASPING FORCEP,90013324,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
CLIPLINE INSULATED OUTER TUBE,90013325,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
CLIPLINE METAL  HANDLE W/HEMOSTATRATCHET,90013326,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
PLATE - 3 HOLE VOLAR LOCKING,90013327,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW - 3.5 X 18 MM CORTICAL AR-8935-18,90013328,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW - 2.4 X24 MM LOCKING,90013329,CDM,278,RC,C1713,HCPCS,both,,,885,442.5,,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,339.84,38.4,,271.872,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,619.5,70,,495.6,percent of total billed charges,70% of billed charges for implant carveouts,708,80,,566.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,309.75,35,,247.8,percent of total billed charges,35% of total billed charges for outpatient setting,690.3,78,,552.24,percent of total billed charges,78% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,619.5,70,,495.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,663.75,75,,531,percent of total billed charges,75% of total billed charges for outpatient setting,734.55,83,,587.64,percent of total billed charges,83% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,442.5,50,,354,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,346.64,39.17,,277.312,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,309.75,734.55,
MASK - AIRSENSE 10 AUTOSET TRI #37208,90013344,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRCURVE 10 VAUTO USA  CO # 37211,90013345,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT F30 MED SYS-SLM #64105,90013346,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
THE STEP FREESTYLE AEROBIC PLATFORM(RED),90013347,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
ASPEN BUFFET WITH STORAGE,90013348,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
AASM FACILITY REACCREDITATION,90013351,CDM,278,RC,C1713,HCPCS,both,,,105,52.5,,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,40.32,38.4,,32.256,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,105,70,,84,percent of total billed charges,70% of total billed charges for outpatient setting,105,75,,84,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,36.75,35,,29.4,percent of total billed charges,35% of total billed charges for outpatient setting,81.9,78,,65.52,percent of total billed charges,78% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,73.5,70,,58.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,75,,63,percent of total billed charges,75% of total billed charges for outpatient setting,87.15,83,,69.72,percent of total billed charges,83% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,52.5,50,,42,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,41.13,39.17,,32.904,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,36.75,105,
NEEDLE - 25GA POSI-STOP COLONS,90013409,CDM,270,RC,,,outpatient,,,350,175,,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.4,38.4,,107.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.5,35,,98,percent of total billed charges,35% of total billed charges for outpatient setting,273,78,,218.4,percent of total billed charges,78% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,245,70,,196,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,262.5,75,,210,percent of total billed charges,75% of total billed charges for outpatient setting,290.5,83,,232.4,percent of total billed charges,83% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,175,50,,140,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.09,39.17,,109.672,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.5,290.5,
SCREW - 3.5 LOCKING 14MM AR-8935CLC-14,90013420,CDM,278,RC,,,both,,,645,322.5,,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,247.68,38.4,,198.144,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,451.5,70,,361.2,percent of total billed charges,70% of billed charges for implant carveouts,516,80,,412.8,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,225.75,35,,180.6,percent of total billed charges,35% of total billed charges for outpatient setting,503.1,78,,402.48,percent of total billed charges,78% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,451.5,70,,361.2,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,483.75,75,,387,percent of total billed charges,75% of total billed charges for outpatient setting,535.35,83,,428.28,percent of total billed charges,83% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,322.5,50,,258,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,252.63,39.17,,202.104,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,225.75,535.35,
PLATE - 3 HOLE RIGHT VOLAR,90013421,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
MOP BUCKET AND WRINGER COMBO,90013422,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
REPLACEMENT CHARGER PORTABLE TABLET,90013423,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SNAP IN THERMAL UNIT ONLY NOBAG,90013424,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
TAX - BECKMAN AND COULTER PROPERTY,90013425,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
PLATE - 3 HOLE LEFT VOLAR,90013433,CDM,278,RC,C1713,HCPCS,both,,,2385,1192.5,,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,915.84,38.4,,732.672,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,1669.5,70,,1335.6,percent of total billed charges,70% of billed charges for implant carveouts,1908,80,,1526.4,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,834.75,35,,667.8,percent of total billed charges,35% of total billed charges for outpatient setting,1860.3,78,,1488.24,percent of total billed charges,78% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,1669.5,70,,1335.6,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1788.75,75,,1431,percent of total billed charges,75% of total billed charges for outpatient setting,1979.55,83,,1583.64,percent of total billed charges,83% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,1192.5,50,,954,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,934.16,39.17,,747.328,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,834.75,1979.55,
SCREW - 3.5 X 13 MM  CORTICAL,90013434,CDM,278,RC,C1713,HCPCS,both,,,180,90,,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,69.12,38.4,,55.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,180,70,,144,percent of total billed charges,70% of total billed charges for outpatient setting,180,75,,144,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,63,35,,50.4,percent of total billed charges,35% of total billed charges for outpatient setting,140.4,78,,112.32,percent of total billed charges,78% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,126,70,,100.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,135,75,,108,percent of total billed charges,75% of total billed charges for outpatient setting,149.4,83,,119.52,percent of total billed charges,83% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,90,50,,72,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,70.5,39.17,,56.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,63,180,
SCREW - 2.4 X 18 MM CORTICAL,90013435,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
SCREW - 2.4 X 20  MM CORTICAL,90013436,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
HEATER SAFETY SWITCH # 00153932,90013437,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
DRAIN PAN DEFROST HEATER ASSEMBLY,90013438,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
PROBE1 AND HARNESS ASSEMBLY,90013439,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
GLOW IN THE DARK PLASTIC PULL CORD,90013440,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
3/32  METAL CRIMP PIECE,90013441,CDM,278,RC,C1713,HCPCS,both,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,330,70,,264,percent of total billed charges,70% of total billed charges for outpatient setting,330,75,,264,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,330,
TIGERTAPE  -   AR-7237-7T,90013451,CDM,270,RC,,,outpatient,,,214.5,107.25,,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.08,35,,60.064,percent of total billed charges,35% of total billed charges for outpatient setting,167.31,78,,133.848,percent of total billed charges,78% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,178.04,83,,142.432,percent of total billed charges,83% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.02,39.17,,67.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,75.08,178.04,
23A 12V STARTER GENERATOR FOR CLUB CAR,90013452,CDM,270,RC,,,outpatient,,,214.5,107.25,,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,82.37,38.4,,65.896,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.08,35,,60.064,percent of total billed charges,35% of total billed charges for outpatient setting,167.31,78,,133.848,percent of total billed charges,78% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,150.15,70,,120.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,160.88,75,,128.704,percent of total billed charges,75% of total billed charges for outpatient setting,178.04,83,,142.432,percent of total billed charges,83% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,107.25,50,,85.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,84.02,39.17,,67.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,75.08,178.04,
CART BUNDLE FOR MSP,90013484,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FOLDER -  PURPLE  2POCKET,90013485,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FOLDER -   RED 2POCKET,90013486,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
FOLDER -   YELLOW 2-POCKET,90013487,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
QUEEN COMFORTER SET - DOBBY BEIGE,90013488,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ICON CONTROLLER MC1648DLS/406077,90013489,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SELF ADHESIVE ACRYLIC MIRROR 8PK,90013490,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SCANNER - CANON IMAGE FORMULA RS40,90013491,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ECODRI-SAFE ABSORBENT ROLL,90013492,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ECODRI-SAFE ABSORBENT ROLL 100PLY,90013493,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CUTTER - MATERIALS BOX,90013494,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COVERS - GIANT POLY BAG 54 X44 X70,90013495,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLOVES - CHEMSTOP 13 L NITRILE 12MIL,90013496,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
UTOPIA  WATERPROOF MATTRESS PROTECTOR,90013502,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
MOHAP BED SHEET SET - QUEEN,90013503,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SAFAVIEH MADISON COLLECTION 6'X9' RUG,90013504,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
COSVIYA GROMMET BLACKOUT RM CURTAINS,90013505,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
NAVY BLUE FLOWERS CANVAS WALL ART,90013506,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
ARTBONES DAHLIA FLOWE SHOWER CURTAIN,90013507,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
BAROSSA DESIGN PLASTIC SHOWER LINER CLR,90013508,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
GLAMBURG  ULTRA SOFT 8-PC TOWEL SET,90013509,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
SONORO KATE BATHROOM RUG,90013510,CDM,270,RC,,,outpatient,,,27,13.5,,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,10.37,38.4,,8.296,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,9.45,35,,7.56,percent of total billed charges,35% of total billed charges for outpatient setting,21.06,78,,16.848,percent of total billed charges,78% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,18.9,70,,15.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,20.25,75,,16.2,percent of total billed charges,75% of total billed charges for outpatient setting,22.41,83,,17.928,percent of total billed charges,83% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,13.5,50,,10.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.58,39.17,,8.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,9.45,22.41,
CURO TIPS DISINFECTING CAPS  #CM5-200,90013518,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
UPPER EXTREMITY STANDARD DISP BLADE 6PK,90013528,CDM,270,RC,,,outpatient,,,1740,870,,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,668.16,38.4,,534.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,668.16,38.4,,534.528,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305,75,,1044,percent of total billed charges,75% of total billed charges for outpatient setting,1305,75,,1044,percent of total billed charges,75% of total billed charges for outpatient setting,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,1305,75,,1044,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,609,35,,487.2,percent of total billed charges,35% of total billed charges for outpatient setting,1357.2,78,,1085.76,percent of total billed charges,78% of total billed charges for outpatient setting,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,1218,70,,974.4,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1305,75,,1044,percent of total billed charges,75% of total billed charges for outpatient setting,1444.2,83,,1155.36,percent of total billed charges,83% of total billed charges for outpatient setting,870,50,,696,percent of total billed charges,50% of total billed charges for outpatient setting,870,50,,696,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,681.52,39.17,,545.216,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,609,1444.2,
UPPER EXTREMITY ONYX DISP BLADE 6PK,90013529,CDM,270,RC,,,outpatient,,,2050,1025,,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,787.2,38.4,,629.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,787.2,38.4,,629.76,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1537.5,75,,1230,percent of total billed charges,75% of total billed charges for outpatient setting,1537.5,75,,1230,percent of total billed charges,75% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1537.5,75,,1230,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,717.5,35,,574,percent of total billed charges,35% of total billed charges for outpatient setting,1599,78,,1279.2,percent of total billed charges,78% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,1435,70,,1148,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1537.5,75,,1230,percent of total billed charges,75% of total billed charges for outpatient setting,1701.5,83,,1361.2,percent of total billed charges,83% of total billed charges for outpatient setting,1025,50,,820,percent of total billed charges,50% of total billed charges for outpatient setting,1025,50,,820,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,802.94,39.17,,642.352,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,717.5,1701.5,
ADAPTER - DISTAL END ENFIT TRANSITION,90013549,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
DISTAL RADIUS TRAY,90013550,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
SHOULDER INSTRUMENT SET (ARTHROSCOPY),90013551,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
ARTHREX INSTRUMENTS,90013552,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
POUCHES - STAPLES THERMAL LETTER 5ML,90013553,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SERVICE CALL - HELTON ELIECTICAL,90013554,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
KODAK PIXPRO 16MP DIGITAL CAMERA,90013555,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
RELAY - STEAMER   ATOE-2825-4,90013556,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
GLYCEROL,90013557,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
WARMER CART,90013559,CDM,270,RC,,,outpatient,,,207,103.5,,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.45,35,,57.96,percent of total billed charges,35% of total billed charges for outpatient setting,161.46,78,,129.168,percent of total billed charges,78% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.81,83,,137.448,percent of total billed charges,83% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.08,39.17,,64.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.45,171.81,
12-COUNT WARMER,90013560,CDM,270,RC,,,outpatient,,,207,103.5,,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.45,35,,57.96,percent of total billed charges,35% of total billed charges for outpatient setting,161.46,78,,129.168,percent of total billed charges,78% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.81,83,,137.448,percent of total billed charges,83% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.08,39.17,,64.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.45,171.81,
ENVELOPE - CHILDREN'S HEALTHCARE,90013561,CDM,270,RC,,,outpatient,,,207,103.5,,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,79.49,38.4,,63.592,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,72.45,35,,57.96,percent of total billed charges,35% of total billed charges for outpatient setting,161.46,78,,129.168,percent of total billed charges,78% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,144.9,70,,115.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,155.25,75,,124.2,percent of total billed charges,75% of total billed charges for outpatient setting,171.81,83,,137.448,percent of total billed charges,83% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,103.5,50,,82.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,81.08,39.17,,64.864,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,72.45,171.81,
CHIN RESTRAINT - 16015,90013562,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
CLIPBOARD - PLASTIC BLACK LETTER SIZE,90013564,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
"SAUDER SHOAL CREEK DESK , JAMOCHA WOOD",90013565,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
OFFICE CHAIR MID BACK DESK CHAIR ERGOMES,90013566,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
STERILITE 3 DRAWER  UNIT,90013567,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
IRIS USA MED PLASTIC STACKABLE OPEN BINS,90013568,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
CHAIR - BEAUTYREST PLATINUM LEATHER EXEC,90013569,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
"AIS 2005 - CODING LICENSE, SINGLE CENTER",90013570,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
"AIS 2005 - CODING LICENSE, SINGLE CENTER",90013571,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
SENSOR - COVIDIEN/NELLCOR SHORT SPO2,90013572,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
CORK AND BAMBOO DRINKWARE SET,90013573,CDM,270,RC,,,outpatient,,,31,15.5,,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,11.9,38.4,,9.52,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,10.85,35,,8.68,percent of total billed charges,35% of total billed charges for outpatient setting,24.18,78,,19.344,percent of total billed charges,78% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,21.7,70,,17.36,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,23.25,75,,18.6,percent of total billed charges,75% of total billed charges for outpatient setting,25.73,83,,20.584,percent of total billed charges,83% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,15.5,50,,12.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,12.14,39.17,,9.712,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,10.85,25.73,
CONTAINER - 116 QT STERILITE,90013580,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VOLAR DISTAL RAD PLT TI STD RT 3H,90013581,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VOLAR DISTAL RAD PLT TI  NARROW LT 3H,90013582,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
VOLAR DISTAL RAD PLT TI  NARROW RT 3H,90013583,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
LO-PRO SCRW TI 3.5MMX 13MM,90013584,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
SUTURE CUTTER OPENENDED LT NOTCH,90013585,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
SUTURE CUTTER 4.2MM STRAIGHT,90013586,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
MINI SUTURE CUTTER,90013587,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
FIBER TAPE RETRIEVER W/SR HANDLE,90013588,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
FASTPASS SCORPION SL-MP,90013589,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
LABRAL SCORPION,90013590,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PUNCH FOR 4.5MM PUSHLOCK,90013591,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PUNCH/TAP FOR BIOCRKSCRW FT,90013592,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PUNCH  FOR CRKSCRW FT & SWVLK ANCHS,90013593,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
FIBER TAPE CUTTER,90013594,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
FIBERWIRE SCISSOR,90013595,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
GASKET 2  STEAM,90013596,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
GASKET 2  RUBBER,90013597,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
REFRIGERATOR LOCK COMBINATION,90013598,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PTAC STEEL INSULATED WALL SLEEVE,90013599,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PTAC ALUMINUM STAMPED GRILLE,90013600,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
PTAC  NON ELECTRICAL SUBBASE,90013601,CDM,270,RC,,,outpatient,,,327,163.5,,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,125.57,38.4,,100.456,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,114.45,35,,91.56,percent of total billed charges,35% of total billed charges for outpatient setting,255.06,78,,204.048,percent of total billed charges,78% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,228.9,70,,183.12,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,245.25,75,,196.2,percent of total billed charges,75% of total billed charges for outpatient setting,271.41,83,,217.128,percent of total billed charges,83% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,163.5,50,,130.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,128.08,39.17,,102.464,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,114.45,271.41,
SIGN - RESERVED PARKING FOR STAFF ONLY,90013602,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FORM - CAAP-2 ARTICULATION RESPONSE,90013603,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
FRIDGE LOCK WITH KEYS,90013620,CDM,270,RC,C1713,HCPCS,outpatient,,,3537,1768.5,,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1358.21,38.4,,1086.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1358.21,38.4,,1086.568,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1237.95,35,,990.36,percent of total billed charges,35% of total billed charges for outpatient setting,2758.86,78,,2207.088,percent of total billed charges,78% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,2475.9,70,,1980.72,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2652.75,75,,2122.2,percent of total billed charges,75% of total billed charges for outpatient setting,2935.71,83,,2348.568,percent of total billed charges,83% of total billed charges for outpatient setting,1768.5,50,,1414.8,percent of total billed charges,50% of total billed charges for outpatient setting,1768.5,50,,1414.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1385.37,39.17,,1108.296,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,1237.95,2935.71,
AIRVIEW -  FULL TIME MONITORING,90013680,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
BANDAGE - 4 5YD STERILE SWIFTWRAP ELASTI,90013727,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
BANDAGE - 6  X5YD STERILE SWIFTWRAP ELAS,90013728,CDM,270,RC,,,outpatient,,,7,3.5,,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,2.69,38.4,,2.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.45,35,,1.96,percent of total billed charges,35% of total billed charges for outpatient setting,5.46,78,,4.368,percent of total billed charges,78% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,4.9,70,,3.92,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,5.25,75,,4.2,percent of total billed charges,75% of total billed charges for outpatient setting,5.81,83,,4.648,percent of total billed charges,83% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,3.5,50,,2.8,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,2.74,39.17,,2.192,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,2.45,5.81,
PAIN0611 EPIDURAL TRAY TERMINATED,90013736,CDM,270,RC,,,outpatient,,,225,112.5,,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,86.4,38.4,,69.12,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,78.75,35,,63,percent of total billed charges,35% of total billed charges for outpatient setting,175.5,78,,140.4,percent of total billed charges,78% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,157.5,70,,126,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,168.75,75,,135,percent of total billed charges,75% of total billed charges for outpatient setting,186.75,83,,149.4,percent of total billed charges,83% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,112.5,50,,90,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,88.13,39.17,,70.504,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,78.75,186.75,
7X7 FLEXIBLE CANNULAS AR-6570F TERMINAT,90013737,CDM,270,RC,,,outpatient,,,196,98,,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,75.26,38.4,,60.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,75.26,38.4,,60.208,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,68.6,35,,54.88,percent of total billed charges,35% of total billed charges for outpatient setting,152.88,78,,122.304,percent of total billed charges,78% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,137.2,70,,109.76,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,147,75,,117.6,percent of total billed charges,75% of total billed charges for outpatient setting,162.68,83,,130.144,percent of total billed charges,83% of total billed charges for outpatient setting,98,50,,78.4,percent of total billed charges,50% of total billed charges for outpatient setting,98,50,,78.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,76.77,39.17,,61.416,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,68.6,162.68,
ENDPOINT  BACKUP - VIRTUAL SERVER,90013757,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
ENDPOINT  BACKUP - WORKSTATION,90013758,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
HYBRID NEBULALFLEX 24 PORT BE L2,90013759,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
ZYXEL 802.11 11AX DUAL RADIO AP WIFI 6,90013760,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
GENERIC COMPAT 1000 TRANSCEIVER MODULE,90013761,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
CUSHION - LACURA GEL FOAM 18X18X1 HALF/H,90013762,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
AXOGUARD NERVE CONNECTOR,90013763,CDM,278,RC,C1713,HCPCS,both,,,1716,858,,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,658.94,38.4,,527.152,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,1201.2,70,,960.96,percent of total billed charges,70% of billed charges for implant carveouts,1372.8,80,,1098.24,percent of total billed charges,80% of billed charges for implant carveouts,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,600.6,35,,480.48,percent of total billed charges,35% of total billed charges for outpatient setting,1338.48,78,,1070.784,percent of total billed charges,78% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,1201.2,70,,960.96,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,1287,75,,1029.6,percent of total billed charges,75% of total billed charges for outpatient setting,1424.28,83,,1139.424,percent of total billed charges,83% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,858,50,,686.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,672.12,39.17,,537.696,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,600.6,1424.28,
BADGE BUDDY - SLP VERTICAL CUSTOM PBLUE,90013801,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - OT VERTICAL CUSTOM PBLUE,90013802,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - PT VERTICAL CUSTOM PBLUE,90013803,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - PTA  VERTICAL CUSTOM PBLUE,90013804,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY -  AIDE VERTICAL CUSTOM,90013805,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
BADGE BUDDY - RT VERTICAL CUSTOM GRAY-V,90013812,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
CHAIR - WAITING ROOM LEATHER,90013813,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SET - TABLE WITH 4 CHAIRS,90013814,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
STANDBY UPS 600VA 360W SURGE PROTECT BAC,90013815,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
FIREWALLS W/ 3YEARS OF XSTREAM SECURITY,90013816,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
ZYXEL TRI BAND WIRELESS ACCESS POINT,90013817,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SCREW - 2.4 X18MM CORTICAL,90013818,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
SCREW - 3.5 X 12MM LOCKING,90013819,CDM,270,RC,,,outpatient,,,351,175.5,,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,134.78,38.4,,107.824,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,122.85,35,,98.28,percent of total billed charges,35% of total billed charges for outpatient setting,273.78,78,,219.024,percent of total billed charges,78% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,245.7,70,,196.56,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,263.25,75,,210.6,percent of total billed charges,75% of total billed charges for outpatient setting,291.33,83,,233.064,percent of total billed charges,83% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,175.5,50,,140.4,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,137.48,39.17,,109.984,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,122.85,291.33,
HEADGEAR - F20 HEADGEAR STD,90013914,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - F20 HEADGEAR STD,90013915,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - F20 HEADGEAR LGE,90013916,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEADGEAR - F20 HEADGEAR SML,90013917,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
DURACALL - WHITE SINGLE 7',90013918,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MOUSE - LOGITECH M310 WIRELESS USB,90013956,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
COMBO - WIRELESS KEYBOARD AND MOUSE,90013994,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
OFFICE BUILDING REPAIRS - SLIDING DOOR,90013995,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
MASK - AIRFIT P10 MASK SYSTEM -AMER,90022925,CDM,270,RC,,,outpatient,,,330,165,,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,126.72,38.4,,101.376,percent of total billed charges,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,115.5,35,,92.4,percent of total billed charges,35% of total billed charges for outpatient setting,257.4,78,,205.92,percent of total billed charges,78% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,231,70,,184.8,percent of total billed charges,70% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,247.5,75,,198,percent of total billed charges,75% of total billed charges for outpatient setting,273.9,83,,219.12,percent of total billed charges,83% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,165,50,,132,percent of total billed charges,50% of total billed charges for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,,,,,other,Not separately reimbursable for outpatient setting,129.25,39.17,,103.4,percent of total billed charges,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,,,,,other,Not separately reimbursable for outpatient setting,115.5,273.9,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,276977.08,130,MS-DRG,221581.664,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,77084.48,100,,,other,100% GA Medicaid DRG rate for inpatient setting,77084.48,100,,61667.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,80938.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,224240.92,100,MS-DRG,179392.736,other,100% UHC DRG rate for inpatient setting,224240.92,100,MS-DRG,179392.736,other,100% UHC DRG rate for inpatient setting,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,78626.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,213059.29,100,MS-DRG,170447.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,77084.48,276977.08,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,127857.86,130,MS-DRG,102286.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51904.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,51904.35,100,,41523.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,54499.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,101319.93,100,MS-DRG,81055.944,other,100% UHC DRG rate for inpatient setting,101319.93,100,MS-DRG,81055.944,other,100% UHC DRG rate for inpatient setting,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52942.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,98352.2,100,MS-DRG,78681.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51904.35,127857.86,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,218970.71,130,MS-DRG,175176.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,76535.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,76535.77,100,,61228.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,80362.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,176425.48,100,MS-DRG,141140.384,other,100% UHC DRG rate for inpatient setting,176425.48,100,MS-DRG,141140.384,other,100% UHC DRG rate for inpatient setting,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,78066.49,102,,,other,102% GA Medicaid DRG rate for inpatient setting,168439.01,100,MS-DRG,134751.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,76535.77,218970.71,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,152511.79,130,MS-DRG,122009.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,55132.32,100,,,other,100% GA Medicaid DRG rate for inpatient setting,55132.32,100,,44105.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57888.94,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,121642.5,100,MS-DRG,97314,other,100% UHC DRG rate for inpatient setting,121642.5,100,MS-DRG,97314,other,100% UHC DRG rate for inpatient setting,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56234.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,117316.76,100,MS-DRG,93853.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,55132.32,152511.79,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,108843.64,130,MS-DRG,87074.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,114766.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,114766.84,100,,91813.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,120505.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,85646.25,100,MS-DRG,68517,other,100% UHC DRG rate for inpatient setting,85646.25,100,MS-DRG,68517,other,100% UHC DRG rate for inpatient setting,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,117062.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,83725.88,100,MS-DRG,66980.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,83725.88,120505.18,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,53499.54,130,MS-DRG,42799.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52291.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,52291.96,100,,41833.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,54906.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40025.35,100,MS-DRG,32020.28,other,100% UHC DRG rate for inpatient setting,40025.35,100,MS-DRG,32020.28,other,100% UHC DRG rate for inpatient setting,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,53337.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,41153.49,100,MS-DRG,32922.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40025.35,54906.56,
LUNG TRANSPLANT,7,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,128081.73,130,MS-DRG,102465.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37328.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,37328.39,100,,29862.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39194.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,101504.46,100,MS-DRG,81203.568,other,100% UHC DRG rate for inpatient setting,101504.46,100,MS-DRG,81203.568,other,100% UHC DRG rate for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38074.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37328.39,128081.73,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,57763.97,130,MS-DRG,46211.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33141.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,33141.29,100,,26513.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34798.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43540.57,100,MS-DRG,34832.456,other,100% UHC DRG rate for inpatient setting,43540.57,100,MS-DRG,34832.456,other,100% UHC DRG rate for inpatient setting,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33804.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,44433.82,100,MS-DRG,35547.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33141.29,57763.97,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,53265.64,130,MS-DRG,42612.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18350.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18350.03,100,,14680.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19267.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39832.54,100,MS-DRG,31866.032,other,100% UHC DRG rate for inpatient setting,39832.54,100,MS-DRG,31866.032,other,100% UHC DRG rate for inpatient setting,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18717.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,40973.57,100,MS-DRG,32778.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18350.03,53265.64,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,56705.88,130,MS-DRG,45364.704,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16241.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,16241.91,100,,12993.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17054,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42668.38,100,MS-DRG,34134.704,other,100% UHC DRG rate for inpatient setting,42668.38,100,MS-DRG,34134.704,other,100% UHC DRG rate for inpatient setting,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16566.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,43619.91,100,MS-DRG,34895.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16241.91,56705.88,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,45147.38,130,MS-DRG,36117.904,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15734.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15734.31,100,,12587.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16521.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33140.55,100,MS-DRG,26512.44,other,100% UHC DRG rate for inpatient setting,33140.55,100,MS-DRG,26512.44,other,100% UHC DRG rate for inpatient setting,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16049,102,,,other,102% GA Medicaid DRG rate for inpatient setting,34728.75,100,MS-DRG,27783,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15734.31,45147.38,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31904.39,130,MS-DRG,25523.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7952.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7952.94,100,,6362.352,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8350.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22224.17,100,MS-DRG,17779.336,other,100% UHC DRG rate for inpatient setting,22224.17,100,MS-DRG,17779.336,other,100% UHC DRG rate for inpatient setting,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8112,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24541.84,100,MS-DRG,19633.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7952.94,31904.39,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,119995.6,130,MS-DRG,95996.48,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,92721.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,92721.61,100,,74177.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,97357.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,94838.95,100,MS-DRG,75871.16,other,100% UHC DRG rate for inpatient setting,94838.95,100,MS-DRG,75871.16,other,100% UHC DRG rate for inpatient setting,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,94576.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,92304.31,100,MS-DRG,73843.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,92304.31,119995.6,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,66952.34,130,MS-DRG,53561.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26530.23,100,,,other,100% GA Medicaid DRG rate for inpatient setting,26530.23,100,,21224.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27856.74,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51114.68,100,MS-DRG,40891.744,other,100% UHC DRG rate for inpatient setting,51114.68,100,MS-DRG,40891.744,other,100% UHC DRG rate for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27060.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26530.23,66952.34,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,66952.34,130,MS-DRG,53561.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12077.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12077.61,100,,9662.088,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12681.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51114.68,100,MS-DRG,40891.744,other,100% UHC DRG rate for inpatient setting,51114.68,100,MS-DRG,40891.744,other,100% UHC DRG rate for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12319.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51501.8,100,MS-DRG,41201.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12077.61,66952.34,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,374794.72,130,MS-DRG,299835.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,304873.34,100,MS-DRG,243898.672,other,100% UHC DRG rate for inpatient setting,304873.34,100,MS-DRG,243898.672,other,100% UHC DRG rate for inpatient setting,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,288303.63,100,MS-DRG,230642.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,288303.63,374794.72,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,85187.56,130,MS-DRG,68150.048,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,66146.21,100,MS-DRG,52916.968,other,100% UHC DRG rate for inpatient setting,66146.21,100,MS-DRG,52916.968,other,100% UHC DRG rate for inpatient setting,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,65528.89,100,MS-DRG,52423.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,65528.89,85187.56,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,89794.32,130,MS-DRG,71835.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37061.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,37061.13,100,,29648.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38914.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,69943.61,100,MS-DRG,55954.888,other,100% UHC DRG rate for inpatient setting,69943.61,100,MS-DRG,55954.888,other,100% UHC DRG rate for inpatient setting,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37802.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,69072.55,100,MS-DRG,55258.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37061.13,89794.32,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,66594.97,130,MS-DRG,53275.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23181.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,23181.9,100,,18545.52,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24340.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50820.09,100,MS-DRG,40656.072,other,100% UHC DRG rate for inpatient setting,50820.09,100,MS-DRG,40656.072,other,100% UHC DRG rate for inpatient setting,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23645.54,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51226.9,100,MS-DRG,40981.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23181.9,66594.97,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,44322.21,130,MS-DRG,35457.768,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15912.23,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15912.23,100,,12729.784,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16707.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28769.69,100,MS-DRG,23015.752,other,100% UHC DRG rate for inpatient setting,28769.69,100,MS-DRG,23015.752,other,100% UHC DRG rate for inpatient setting,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16230.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,34094.01,100,MS-DRG,27275.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15912.23,44322.21,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,61850.7,130,MS-DRG,49480.56,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21924.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,21924.5,100,,17539.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23020.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,46909.32,100,MS-DRG,37527.456,other,100% UHC DRG rate for inpatient setting,46909.32,100,MS-DRG,37527.456,other,100% UHC DRG rate for inpatient setting,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22362.99,102,,,other,102% GA Medicaid DRG rate for inpatient setting,47577.46,100,MS-DRG,38061.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21924.5,61850.7,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42978.03,130,MS-DRG,34382.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12015.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12015.94,100,,9612.752,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12616.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31352.32,100,MS-DRG,25081.856,other,100% UHC DRG rate for inpatient setting,31352.32,100,MS-DRG,25081.856,other,100% UHC DRG rate for inpatient setting,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12256.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33060.02,100,MS-DRG,26448.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12015.94,42978.03,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,49274.28,130,MS-DRG,39419.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18863.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18863.98,100,,15091.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19807.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36542.4,100,MS-DRG,29233.92,other,100% UHC DRG rate for inpatient setting,36542.4,100,MS-DRG,29233.92,other,100% UHC DRG rate for inpatient setting,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19241.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,37903.29,100,MS-DRG,30322.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18863.98,49274.28,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34588.72,130,MS-DRG,27670.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12755.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12755.28,100,,10204.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13393.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24436.9,100,MS-DRG,19549.52,other,100% UHC DRG rate for inpatient setting,24436.9,100,MS-DRG,19549.52,other,100% UHC DRG rate for inpatient setting,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13010.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26606.71,100,MS-DRG,21285.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12755.28,34588.72,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29366.61,130,MS-DRG,23493.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9938.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9938.84,100,,7951.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10435.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20132.25,100,MS-DRG,16105.8,other,100% UHC DRG rate for inpatient setting,20132.25,100,MS-DRG,16105.8,other,100% UHC DRG rate for inpatient setting,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10137.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22589.7,100,MS-DRG,18071.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9938.84,29366.61,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,65437.52,130,MS-DRG,52350.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18753.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18753.34,100,,15002.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19691.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49865.98,100,MS-DRG,39892.784,other,100% UHC DRG rate for inpatient setting,49865.98,100,MS-DRG,39892.784,other,100% UHC DRG rate for inpatient setting,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19128.41,102,,,other,102% GA Medicaid DRG rate for inpatient setting,50336.55,100,MS-DRG,40269.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18753.34,65437.52,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39358.07,130,MS-DRG,31486.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11700.09,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11700.09,100,,9360.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12285.1,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28368.36,100,MS-DRG,22694.688,other,100% UHC DRG rate for inpatient setting,28368.36,100,MS-DRG,22694.688,other,100% UHC DRG rate for inpatient setting,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11934.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30275.44,100,MS-DRG,24220.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11700.09,39358.07,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28223.21,130,MS-DRG,22578.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7821.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7821.74,100,,6257.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8212.83,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19189.73,100,MS-DRG,15351.784,other,100% UHC DRG rate for inpatient setting,19189.73,100,MS-DRG,15351.784,other,100% UHC DRG rate for inpatient setting,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7978.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21710.16,100,MS-DRG,17368.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7821.74,28223.21,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,46268.69,130,MS-DRG,37014.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9425.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9425.64,100,,7540.512,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9896.92,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34064.87,100,MS-DRG,27251.896,other,100% UHC DRG rate for inpatient setting,34064.87,100,MS-DRG,27251.896,other,100% UHC DRG rate for inpatient setting,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9614.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35591.3,100,MS-DRG,28473.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9425.64,46268.69,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26564.82,130,MS-DRG,21251.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6036.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6036.94,100,,4829.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6338.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17822.7,100,MS-DRG,14258.16,other,100% UHC DRG rate for inpatient setting,17822.7,100,MS-DRG,14258.16,other,100% UHC DRG rate for inpatient setting,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6157.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20434.48,100,MS-DRG,16347.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6036.94,26564.82,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21235.32,130,MS-DRG,16988.256,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4967.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4967.18,100,,3973.744,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5215.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13429.5,100,MS-DRG,10743.6,other,100% UHC DRG rate for inpatient setting,13429.5,100,MS-DRG,10743.6,other,100% UHC DRG rate for inpatient setting,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5066.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16334.86,100,MS-DRG,13067.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4967.18,21235.32,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,44108.39,130,MS-DRG,35286.712,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16382.07,100,,,other,100% GA Medicaid DRG rate for inpatient setting,16382.07,100,,13105.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17201.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32284.09,100,MS-DRG,25827.272,other,100% UHC DRG rate for inpatient setting,32284.09,100,MS-DRG,25827.272,other,100% UHC DRG rate for inpatient setting,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16709.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33929.53,100,MS-DRG,27143.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16382.07,44108.39,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28027.45,130,MS-DRG,22421.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7563.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7563.46,100,,6050.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7941.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19028.36,100,MS-DRG,15222.688,other,100% UHC DRG rate for inpatient setting,19028.36,100,MS-DRG,15222.688,other,100% UHC DRG rate for inpatient setting,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7714.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21559.58,100,MS-DRG,17247.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7563.46,28027.45,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23095.46,130,MS-DRG,18476.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4892.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4892.79,100,,3914.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5137.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14962.86,100,MS-DRG,11970.288,other,100% UHC DRG rate for inpatient setting,14962.86,100,MS-DRG,11970.288,other,100% UHC DRG rate for inpatient setting,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4990.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17765.74,100,MS-DRG,14212.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4892.79,23095.46,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38830.05,130,MS-DRG,31064.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10053.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10053.59,100,,8042.872,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10556.27,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27933.09,100,MS-DRG,22346.472,other,100% UHC DRG rate for inpatient setting,27933.09,100,MS-DRG,22346.472,other,100% UHC DRG rate for inpatient setting,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10254.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29869.27,100,MS-DRG,23895.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10053.59,38830.05,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21004.43,130,MS-DRG,16803.544,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6834.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6834.59,100,,5467.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7176.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13239.17,100,MS-DRG,10591.336,other,100% UHC DRG rate for inpatient setting,13239.17,100,MS-DRG,10591.336,other,100% UHC DRG rate for inpatient setting,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6971.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16157.25,100,MS-DRG,12925.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6834.59,21004.43,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16397.68,130,MS-DRG,13118.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4276.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4276.8,100,,3421.44,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4490.64,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9441.78,100,MS-DRG,7553.424,other,100% UHC DRG rate for inpatient setting,9441.78,100,MS-DRG,7553.424,other,100% UHC DRG rate for inpatient setting,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4362.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12613.6,100,MS-DRG,10090.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4276.8,16397.68,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,43597.41,130,MS-DRG,34877.928,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11080.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11080.74,100,,8864.592,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11634.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31862.89,100,MS-DRG,25490.312,other,100% UHC DRG rate for inpatient setting,31862.89,100,MS-DRG,25490.312,other,100% UHC DRG rate for inpatient setting,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11302.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33536.47,100,MS-DRG,26829.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11080.74,43597.41,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27336.8,130,MS-DRG,21869.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10796.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10796.66,100,,8637.328,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11336.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18459.04,100,MS-DRG,14767.232,other,100% UHC DRG rate for inpatient setting,18459.04,100,MS-DRG,14767.232,other,100% UHC DRG rate for inpatient setting,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11012.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21028.31,100,MS-DRG,16822.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10796.66,27336.8,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22408.83,130,MS-DRG,17927.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5404.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5404.13,100,,4323.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5674.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14396.85,100,MS-DRG,11517.48,other,100% UHC DRG rate for inpatient setting,14396.85,100,MS-DRG,11517.48,other,100% UHC DRG rate for inpatient setting,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5512.21,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17237.56,100,MS-DRG,13790.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5404.13,22408.83,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24463.73,130,MS-DRG,19570.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29296.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,29296.21,100,,23436.968,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30761.02,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16090.74,100,MS-DRG,12872.592,other,100% UHC DRG rate for inpatient setting,16090.74,100,MS-DRG,12872.592,other,100% UHC DRG rate for inpatient setting,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29882.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18818.25,100,MS-DRG,15054.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16090.74,30761.02,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14819.61,130,MS-DRG,11855.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3039.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3039.59,100,,2431.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3191.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8140.95,100,MS-DRG,6512.76,other,100% UHC DRG rate for inpatient setting,8140.95,100,MS-DRG,6512.76,other,100% UHC DRG rate for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3100.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3039.59,14819.61,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19735.53,130,MS-DRG,15788.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6372.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6372.22,100,,5097.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6690.83,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12193.21,100,MS-DRG,9754.568,other,100% UHC DRG rate for inpatient setting,12193.21,100,MS-DRG,9754.568,other,100% UHC DRG rate for inpatient setting,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6499.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15181.18,100,MS-DRG,12144.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6372.22,19735.53,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15717.07,130,MS-DRG,12573.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5078.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5078.56,100,,4062.848,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5332.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8880.73,100,MS-DRG,7104.584,other,100% UHC DRG rate for inpatient setting,8880.73,100,MS-DRG,7104.584,other,100% UHC DRG rate for inpatient setting,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5180.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12090.05,100,MS-DRG,9672.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5078.56,15717.07,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28976.12,130,MS-DRG,23180.896,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10918.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10918.89,100,,8735.112,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11464.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19810.35,100,MS-DRG,15848.28,other,100% UHC DRG rate for inpatient setting,19810.35,100,MS-DRG,15848.28,other,100% UHC DRG rate for inpatient setting,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11137.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22289.32,100,MS-DRG,17831.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10918.89,28976.12,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18628.26,130,MS-DRG,14902.608,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5970.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5970.78,100,,4776.624,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6269.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11280.48,100,MS-DRG,9024.384,other,100% UHC DRG rate for inpatient setting,11280.48,100,MS-DRG,9024.384,other,100% UHC DRG rate for inpatient setting,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6090.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14329.43,100,MS-DRG,11463.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5970.78,18628.26,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22289.37,130,MS-DRG,17831.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4897.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4897.65,100,,3918.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5142.54,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14298.37,100,MS-DRG,11438.696,other,100% UHC DRG rate for inpatient setting,14298.37,100,MS-DRG,11438.696,other,100% UHC DRG rate for inpatient setting,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4995.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17145.67,100,MS-DRG,13716.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4897.65,22289.37,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16861.47,130,MS-DRG,13489.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4886.81,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4886.81,100,,3909.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5131.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9824.08,100,MS-DRG,7859.264,other,100% UHC DRG rate for inpatient setting,9824.08,100,MS-DRG,7859.264,other,100% UHC DRG rate for inpatient setting,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4984.55,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12970.36,100,MS-DRG,10376.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4886.81,16861.47,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13952.26,130,MS-DRG,11161.808,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3175.27,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3175.27,100,,2540.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3334.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7425.99,100,MS-DRG,5940.792,other,100% UHC DRG rate for inpatient setting,7425.99,100,MS-DRG,5940.792,other,100% UHC DRG rate for inpatient setting,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3238.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10732.51,100,MS-DRG,8586.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3175.27,13952.26,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33079.92,130,MS-DRG,26463.936,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8653.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8653.03,100,,6922.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9085.68,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23193.17,100,MS-DRG,18554.536,other,100% UHC DRG rate for inpatient setting,23193.17,100,MS-DRG,18554.536,other,100% UHC DRG rate for inpatient setting,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8826.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25446.09,100,MS-DRG,20356.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8653.03,33079.92,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23732.93,130,MS-DRG,18986.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6319.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6319.52,100,,5055.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6635.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15488.32,100,MS-DRG,12390.656,other,100% UHC DRG rate for inpatient setting,15488.32,100,MS-DRG,12390.656,other,100% UHC DRG rate for inpatient setting,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6445.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18256.1,100,MS-DRG,14604.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6319.52,23732.93,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19869.04,130,MS-DRG,15895.232,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5567.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5567.84,100,,4454.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5846.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12303.27,100,MS-DRG,9842.616,other,100% UHC DRG rate for inpatient setting,12303.27,100,MS-DRG,9842.616,other,100% UHC DRG rate for inpatient setting,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5679.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15283.88,100,MS-DRG,12227.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5567.84,19869.04,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25051,130,MS-DRG,20040.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10039.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10039.01,100,,8031.208,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10540.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16574.83,100,MS-DRG,13259.864,other,100% UHC DRG rate for inpatient setting,16574.83,100,MS-DRG,13259.864,other,100% UHC DRG rate for inpatient setting,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10239.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19270,100,MS-DRG,15416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10039.01,25051,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15146.87,130,MS-DRG,12117.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5426.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5426.18,100,,4340.944,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5697.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8410.71,100,MS-DRG,6728.568,other,100% UHC DRG rate for inpatient setting,8410.71,100,MS-DRG,6728.568,other,100% UHC DRG rate for inpatient setting,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5534.7,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11651.44,100,MS-DRG,9321.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5426.18,15146.87,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11845.16,130,MS-DRG,9476.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3065.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3065.75,100,,2452.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3219.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5689.06,100,MS-DRG,4551.248,other,100% UHC DRG rate for inpatient setting,5689.06,100,MS-DRG,4551.248,other,100% UHC DRG rate for inpatient setting,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3127.07,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9111.66,100,MS-DRG,7289.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3065.75,11845.16,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19167.34,130,MS-DRG,15333.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4228.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4228.21,100,,3382.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4439.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11724.85,100,MS-DRG,9379.88,other,100% UHC DRG rate for inpatient setting,11724.85,100,MS-DRG,9379.88,other,100% UHC DRG rate for inpatient setting,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4312.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14744.11,100,MS-DRG,11795.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4228.21,19167.34,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13687.23,130,MS-DRG,10949.784,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2959.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2959.6,100,,2367.68,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3107.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7207.53,100,MS-DRG,5766.024,other,100% UHC DRG rate for inpatient setting,7207.53,100,MS-DRG,5766.024,other,100% UHC DRG rate for inpatient setting,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3018.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10528.64,100,MS-DRG,8422.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2959.6,13687.23,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12961.44,130,MS-DRG,10369.152,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2840.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2840.36,100,,2272.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2982.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6609.24,100,MS-DRG,5287.392,other,100% UHC DRG rate for inpatient setting,6609.24,100,MS-DRG,5287.392,other,100% UHC DRG rate for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2897.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2840.36,12961.44,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22907.76,130,MS-DRG,18326.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7080.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7080.16,100,,5664.128,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7434.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14808.11,100,MS-DRG,11846.488,other,100% UHC DRG rate for inpatient setting,14808.11,100,MS-DRG,11846.488,other,100% UHC DRG rate for inpatient setting,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7221.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17621.35,100,MS-DRG,14097.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7080.16,22907.76,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15602.63,130,MS-DRG,12482.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4508.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4508.55,100,,3606.84,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4733.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8786.4,100,MS-DRG,7029.12,other,100% UHC DRG rate for inpatient setting,8786.4,100,MS-DRG,7029.12,other,100% UHC DRG rate for inpatient setting,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4598.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12002.02,100,MS-DRG,9601.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4508.55,15602.63,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12803.84,130,MS-DRG,10243.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2543.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2543.58,100,,2034.864,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2670.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6479.33,100,MS-DRG,5183.464,other,100% UHC DRG rate for inpatient setting,6479.33,100,MS-DRG,5183.464,other,100% UHC DRG rate for inpatient setting,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2594.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9849.11,100,MS-DRG,7879.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2543.58,12803.84,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20132.06,130,MS-DRG,16105.648,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5585.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5585.04,100,,4468.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5864.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12520.08,100,MS-DRG,10016.064,other,100% UHC DRG rate for inpatient setting,12520.08,100,MS-DRG,10016.064,other,100% UHC DRG rate for inpatient setting,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5696.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15486.2,100,MS-DRG,12388.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5585.04,20132.06,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15245.24,130,MS-DRG,12196.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3545.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3545.69,100,,2836.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3722.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8491.81,100,MS-DRG,6793.448,other,100% UHC DRG rate for inpatient setting,8491.81,100,MS-DRG,6793.448,other,100% UHC DRG rate for inpatient setting,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3616.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11727.11,100,MS-DRG,9381.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3545.69,15245.24,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24155.55,130,MS-DRG,19324.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3462.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3462.71,100,,2770.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3635.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15836.7,100,MS-DRG,12669.36,other,100% UHC DRG rate for inpatient setting,15836.7,100,MS-DRG,12669.36,other,100% UHC DRG rate for inpatient setting,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3531.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18581.19,100,MS-DRG,14864.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3462.71,24155.55,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14204.23,130,MS-DRG,11363.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2066.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2066.26,100,,1653.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2169.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7633.69,100,MS-DRG,6106.952,other,100% UHC DRG rate for inpatient setting,7633.69,100,MS-DRG,6106.952,other,100% UHC DRG rate for inpatient setting,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2107.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10926.33,100,MS-DRG,8741.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2066.26,14204.23,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20110.97,130,MS-DRG,16088.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4070.85,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4070.85,100,,3256.68,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4274.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12502.7,100,MS-DRG,10002.16,other,100% UHC DRG rate for inpatient setting,12502.7,100,MS-DRG,10002.16,other,100% UHC DRG rate for inpatient setting,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4152.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15469.98,100,MS-DRG,12375.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4070.85,20110.97,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15151.88,130,MS-DRG,12121.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3715.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3715.01,100,,2972.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3900.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8414.85,100,MS-DRG,6731.88,other,100% UHC DRG rate for inpatient setting,8414.85,100,MS-DRG,6731.88,other,100% UHC DRG rate for inpatient setting,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3789.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11655.29,100,MS-DRG,9324.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3715.01,15151.88,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12380.21,130,MS-DRG,9904.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2489.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2489.38,100,,1991.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2613.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6130.12,100,MS-DRG,4904.096,other,100% UHC DRG rate for inpatient setting,6130.12,100,MS-DRG,4904.096,other,100% UHC DRG rate for inpatient setting,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2539.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9523.24,100,MS-DRG,7618.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2489.38,12380.21,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27115.95,130,MS-DRG,21692.76,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2942.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2942.03,100,,2353.624,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3089.13,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18276.99,100,MS-DRG,14621.592,other,100% UHC DRG rate for inpatient setting,18276.99,100,MS-DRG,14621.592,other,100% UHC DRG rate for inpatient setting,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3000.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20858.42,100,MS-DRG,16686.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2942.03,27115.95,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14073.74,130,MS-DRG,11258.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1964.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1964.97,100,,1571.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2063.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7526.11,100,MS-DRG,6020.888,other,100% UHC DRG rate for inpatient setting,7526.11,100,MS-DRG,6020.888,other,100% UHC DRG rate for inpatient setting,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2004.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10825.95,100,MS-DRG,8660.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1964.97,14073.74,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27814.66,130,MS-DRG,22251.728,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6689.93,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6689.93,100,,5351.944,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7024.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18852.93,100,MS-DRG,15082.344,other,100% UHC DRG rate for inpatient setting,18852.93,100,MS-DRG,15082.344,other,100% UHC DRG rate for inpatient setting,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6823.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21395.89,100,MS-DRG,17116.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6689.93,27814.66,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18560.01,130,MS-DRG,14848.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4452.85,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4452.85,100,,3562.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4675.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11224.21,100,MS-DRG,8979.368,other,100% UHC DRG rate for inpatient setting,11224.21,100,MS-DRG,8979.368,other,100% UHC DRG rate for inpatient setting,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4541.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14276.93,100,MS-DRG,11421.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4452.85,18560.01,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14176.12,130,MS-DRG,11340.896,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3284.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3284.79,100,,2627.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3449.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7610.52,100,MS-DRG,6088.416,other,100% UHC DRG rate for inpatient setting,7610.52,100,MS-DRG,6088.416,other,100% UHC DRG rate for inpatient setting,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3350.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10904.71,100,MS-DRG,8723.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3284.79,14176.12,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27759.43,130,MS-DRG,22207.544,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5802.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5802.58,100,,4642.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6092.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18807.42,100,MS-DRG,15045.936,other,100% UHC DRG rate for inpatient setting,18807.42,100,MS-DRG,15045.936,other,100% UHC DRG rate for inpatient setting,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5918.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21353.41,100,MS-DRG,17082.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5802.58,27759.43,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18165.49,130,MS-DRG,14532.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3237.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3237.69,100,,2590.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3399.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10899,100,MS-DRG,8719.2,other,100% UHC DRG rate for inpatient setting,10899,100,MS-DRG,8719.2,other,100% UHC DRG rate for inpatient setting,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3302.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13973.45,100,MS-DRG,11178.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3237.69,18165.49,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13839.83,130,MS-DRG,11071.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2503.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2503.96,100,,2003.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2629.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7333.31,100,MS-DRG,5866.648,other,100% UHC DRG rate for inpatient setting,7333.31,100,MS-DRG,5866.648,other,100% UHC DRG rate for inpatient setting,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2554.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10646.02,100,MS-DRG,8516.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2503.96,13839.83,
CONCUSSION WITH MCC,88,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20340.87,130,MS-DRG,16272.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5012.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5012.78,100,,4010.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5263.42,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12692.2,100,MS-DRG,10153.76,other,100% UHC DRG rate for inpatient setting,12692.2,100,MS-DRG,10153.76,other,100% UHC DRG rate for inpatient setting,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5113.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15646.82,100,MS-DRG,12517.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5012.78,20340.87,
CONCUSSION WITH CC,89,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16487.03,130,MS-DRG,13189.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4016.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4016.65,100,,3213.32,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4217.48,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9515.42,100,MS-DRG,7612.336,other,100% UHC DRG rate for inpatient setting,9515.42,100,MS-DRG,7612.336,other,100% UHC DRG rate for inpatient setting,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4096.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12682.33,100,MS-DRG,10145.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4016.65,16487.03,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14327.72,130,MS-DRG,11462.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2393.32,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2393.32,100,,1914.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2512.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7735.47,100,MS-DRG,6188.376,other,100% UHC DRG rate for inpatient setting,7735.47,100,MS-DRG,6188.376,other,100% UHC DRG rate for inpatient setting,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2441.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11021.32,100,MS-DRG,8817.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2393.32,14327.72,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22904.74,130,MS-DRG,18323.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8615.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8615.65,100,,6892.52,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9046.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14805.63,100,MS-DRG,11844.504,other,100% UHC DRG rate for inpatient setting,14805.63,100,MS-DRG,11844.504,other,100% UHC DRG rate for inpatient setting,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8787.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17619.03,100,MS-DRG,14095.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8615.65,22904.74,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15244.24,130,MS-DRG,12195.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4288.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4288.02,100,,3430.416,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4502.42,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8490.98,100,MS-DRG,6792.784,other,100% UHC DRG rate for inpatient setting,8490.98,100,MS-DRG,6792.784,other,100% UHC DRG rate for inpatient setting,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4373.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11726.34,100,MS-DRG,9381.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4288.02,15244.24,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12717.51,130,MS-DRG,10174.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3137.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3137.14,100,,2509.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3294,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6408.16,100,MS-DRG,5126.528,other,100% UHC DRG rate for inpatient setting,6408.16,100,MS-DRG,5126.528,other,100% UHC DRG rate for inpatient setting,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3199.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9782.7,100,MS-DRG,7826.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3137.14,12717.51,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41310.61,130,MS-DRG,33048.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17201.4,100,,,other,100% GA Medicaid DRG rate for inpatient setting,17201.4,100,,13761.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18061.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29977.84,100,MS-DRG,23982.272,other,100% UHC DRG rate for inpatient setting,29977.84,100,MS-DRG,23982.272,other,100% UHC DRG rate for inpatient setting,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17545.43,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31777.39,100,MS-DRG,25421.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17201.4,41310.61,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28877.75,130,MS-DRG,23102.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13765.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13765.61,100,,11012.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14453.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19729.26,100,MS-DRG,15783.408,other,100% UHC DRG rate for inpatient setting,19729.26,100,MS-DRG,15783.408,other,100% UHC DRG rate for inpatient setting,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14040.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22213.65,100,MS-DRG,17770.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13765.61,28877.75,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26824.84,130,MS-DRG,21459.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7322,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7322,100,,5857.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7688.1,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18037.02,100,MS-DRG,14429.616,other,100% UHC DRG rate for inpatient setting,18037.02,100,MS-DRG,14429.616,other,100% UHC DRG rate for inpatient setting,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7468.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20634.49,100,MS-DRG,16507.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7322,26824.84,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41453.17,130,MS-DRG,33162.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13083.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13083.46,100,,10466.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13737.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30095.35,100,MS-DRG,24076.28,other,100% UHC DRG rate for inpatient setting,30095.35,100,MS-DRG,24076.28,other,100% UHC DRG rate for inpatient setting,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13345.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31887.05,100,MS-DRG,25509.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13083.46,41453.17,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26571.87,130,MS-DRG,21257.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7566.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7566.08,100,,6052.864,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7944.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17828.49,100,MS-DRG,14262.792,other,100% UHC DRG rate for inpatient setting,17828.49,100,MS-DRG,14262.792,other,100% UHC DRG rate for inpatient setting,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7717.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20439.9,100,MS-DRG,16351.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7566.08,26571.87,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18196.61,130,MS-DRG,14557.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3682.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3682.49,100,,2945.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3866.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10924.66,100,MS-DRG,8739.728,other,100% UHC DRG rate for inpatient setting,10924.66,100,MS-DRG,8739.728,other,100% UHC DRG rate for inpatient setting,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3756.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13997.39,100,MS-DRG,11197.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3682.49,18196.61,
SEIZURES WITH MCC,100,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24845.21,130,MS-DRG,19876.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6347.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6347.55,100,,5078.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6664.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16405.19,100,MS-DRG,13124.152,other,100% UHC DRG rate for inpatient setting,16405.19,100,MS-DRG,13124.152,other,100% UHC DRG rate for inpatient setting,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6474.5,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19111.7,100,MS-DRG,15289.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6347.55,24845.21,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14074.72,130,MS-DRG,11259.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2862.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2862.04,100,,2289.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3005.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7526.94,100,MS-DRG,6021.552,other,100% UHC DRG rate for inpatient setting,7526.94,100,MS-DRG,6021.552,other,100% UHC DRG rate for inpatient setting,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2919.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10826.71,100,MS-DRG,8661.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2862.04,14074.72,
HEADACHES WITH MCC,102,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17056.23,130,MS-DRG,13644.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3421.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3421.59,100,,2737.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3592.67,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9984.62,100,MS-DRG,7987.696,other,100% UHC DRG rate for inpatient setting,9984.62,100,MS-DRG,7987.696,other,100% UHC DRG rate for inpatient setting,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3490.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13120.18,100,MS-DRG,10496.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3421.59,17056.23,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13400.15,130,MS-DRG,10720.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2635.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2635.53,100,,2108.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2767.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6970.86,100,MS-DRG,5576.688,other,100% UHC DRG rate for inpatient setting,6970.86,100,MS-DRG,5576.688,other,100% UHC DRG rate for inpatient setting,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2688.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10307.81,100,MS-DRG,8246.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2635.53,13400.15,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30113.5,130,MS-DRG,24090.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6773.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6773.66,100,,5418.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7112.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20747.91,100,MS-DRG,16598.328,other,100% UHC DRG rate for inpatient setting,20747.91,100,MS-DRG,16598.328,other,100% UHC DRG rate for inpatient setting,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6909.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23164.23,100,MS-DRG,18531.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6773.66,30113.5,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17309.2,130,MS-DRG,13847.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4359.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4359.41,100,,3487.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4577.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10193.15,100,MS-DRG,8154.52,other,100% UHC DRG rate for inpatient setting,10193.15,100,MS-DRG,8154.52,other,100% UHC DRG rate for inpatient setting,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4446.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13314.77,100,MS-DRG,10651.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4359.41,17309.2,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20648.06,130,MS-DRG,16518.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4700.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4700.67,100,,3760.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4935.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12945.41,100,MS-DRG,10356.328,other,100% UHC DRG rate for inpatient setting,12945.41,100,MS-DRG,10356.328,other,100% UHC DRG rate for inpatient setting,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4794.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15883.12,100,MS-DRG,12706.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4700.67,20648.06,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23322.34,130,MS-DRG,18657.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4801.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4801.59,100,,3841.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5041.67,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15149.87,100,MS-DRG,12119.896,other,100% UHC DRG rate for inpatient setting,15149.87,100,MS-DRG,12119.896,other,100% UHC DRG rate for inpatient setting,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4897.62,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17940.26,100,MS-DRG,14352.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4801.59,23322.34,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16973.89,130,MS-DRG,13579.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3518.4,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3518.4,100,,2814.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3694.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9916.76,100,MS-DRG,7933.408,other,100% UHC DRG rate for inpatient setting,9916.76,100,MS-DRG,7933.408,other,100% UHC DRG rate for inpatient setting,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3588.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13056.84,100,MS-DRG,10445.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3518.4,16973.89,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17805.1,130,MS-DRG,14244.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2342.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2342.11,100,,1873.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2459.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10601.93,100,MS-DRG,8481.544,other,100% UHC DRG rate for inpatient setting,10601.93,100,MS-DRG,8481.544,other,100% UHC DRG rate for inpatient setting,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2388.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13696.23,100,MS-DRG,10956.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2342.11,17805.1,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12417.35,130,MS-DRG,9933.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1996.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1996.74,100,,1597.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2096.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6160.74,100,MS-DRG,4928.592,other,100% UHC DRG rate for inpatient setting,6160.74,100,MS-DRG,4928.592,other,100% UHC DRG rate for inpatient setting,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2036.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9551.81,100,MS-DRG,7641.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1996.74,12417.35,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13014.65,130,MS-DRG,10411.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3099.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3099.77,100,,2479.816,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3254.75,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6653.1,100,MS-DRG,5322.48,other,100% UHC DRG rate for inpatient setting,6653.1,100,MS-DRG,5322.48,other,100% UHC DRG rate for inpatient setting,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3161.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10011.27,100,MS-DRG,8009.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3099.77,13014.65,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18213.68,130,MS-DRG,14570.944,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3235.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3235.82,100,,2588.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3397.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10938.72,100,MS-DRG,8750.976,other,100% UHC DRG rate for inpatient setting,10938.72,100,MS-DRG,8750.976,other,100% UHC DRG rate for inpatient setting,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3300.54,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14010.52,100,MS-DRG,11208.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3235.82,18213.68,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12949.4,130,MS-DRG,10359.52,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2017.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2017.67,100,,1614.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2118.55,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6599.31,100,MS-DRG,5279.448,other,100% UHC DRG rate for inpatient setting,6599.31,100,MS-DRG,5279.448,other,100% UHC DRG rate for inpatient setting,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2058.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9961.08,100,MS-DRG,7968.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2017.67,12949.4,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31567.09,130,MS-DRG,25253.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7596.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7596.73,100,,6077.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7976.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21946.13,100,MS-DRG,17556.904,other,100% UHC DRG rate for inpatient setting,21946.13,100,MS-DRG,17556.904,other,100% UHC DRG rate for inpatient setting,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7748.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24282.38,100,MS-DRG,19425.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7596.73,31567.09,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15426.94,130,MS-DRG,12341.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3871.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3871.25,100,,3097,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4064.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7771.05,100,MS-DRG,6216.84,other,100% UHC DRG rate for inpatient setting,7771.05,100,MS-DRG,6216.84,other,100% UHC DRG rate for inpatient setting,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3948.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11866.88,100,MS-DRG,9493.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3871.25,15426.94,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20048.74,130,MS-DRG,16038.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3459.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3459.34,100,,2767.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3632.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12451.39,100,MS-DRG,9961.112,other,100% UHC DRG rate for inpatient setting,12451.39,100,MS-DRG,9961.112,other,100% UHC DRG rate for inpatient setting,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3528.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15422.11,100,MS-DRG,12337.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3459.34,20048.74,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13634.05,130,MS-DRG,10907.24,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2557.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2557.41,100,,2045.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2685.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7163.67,100,MS-DRG,5730.936,other,100% UHC DRG rate for inpatient setting,7163.67,100,MS-DRG,5730.936,other,100% UHC DRG rate for inpatient setting,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2608.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10487.73,100,MS-DRG,8390.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2557.41,13634.05,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16866.49,130,MS-DRG,13493.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3846.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3846.58,100,,3077.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4038.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9828.22,100,MS-DRG,7862.576,other,100% UHC DRG rate for inpatient setting,9828.22,100,MS-DRG,7862.576,other,100% UHC DRG rate for inpatient setting,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3923.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12974.22,100,MS-DRG,10379.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3846.58,16866.49,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42870.61,130,MS-DRG,34296.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2472.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2472.56,100,,1978.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2596.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31263.78,100,MS-DRG,25011.024,other,100% UHC DRG rate for inpatient setting,31263.78,100,MS-DRG,25011.024,other,100% UHC DRG rate for inpatient setting,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2522.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32977.39,100,MS-DRG,26381.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2472.56,42870.61,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25740.66,130,MS-DRG,20592.528,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2076.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2076.35,100,,1661.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2180.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17143.32,100,MS-DRG,13714.656,other,100% UHC DRG rate for inpatient setting,17143.32,100,MS-DRG,13714.656,other,100% UHC DRG rate for inpatient setting,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2117.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19800.51,100,MS-DRG,15840.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2076.35,25740.66,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20453.3,130,MS-DRG,16362.64,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4967.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4967.55,100,,3974.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5215.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12784.88,100,MS-DRG,10227.904,other,100% UHC DRG rate for inpatient setting,12784.88,100,MS-DRG,10227.904,other,100% UHC DRG rate for inpatient setting,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5066.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15733.31,100,MS-DRG,12586.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4967.55,20453.3,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38328.12,130,MS-DRG,30662.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8448.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8448.95,100,,6759.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8871.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27519.34,100,MS-DRG,22015.472,other,100% UHC DRG rate for inpatient setting,27519.34,100,MS-DRG,22015.472,other,100% UHC DRG rate for inpatient setting,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8617.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29483.17,100,MS-DRG,23586.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8448.95,38328.12,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22315.46,130,MS-DRG,17852.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2374.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2374.63,100,,1899.704,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2493.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14319.89,100,MS-DRG,11455.912,other,100% UHC DRG rate for inpatient setting,14319.89,100,MS-DRG,11455.912,other,100% UHC DRG rate for inpatient setting,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2422.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17165.74,100,MS-DRG,13732.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2374.63,22315.46,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17201.78,130,MS-DRG,13761.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2621.7,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2621.7,100,,2097.36,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2752.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10104.6,100,MS-DRG,8083.68,other,100% UHC DRG rate for inpatient setting,10104.6,100,MS-DRG,8083.68,other,100% UHC DRG rate for inpatient setting,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2674.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13232.14,100,MS-DRG,10585.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2621.7,17201.78,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26135.17,130,MS-DRG,20908.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5037.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5037.82,100,,4030.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5289.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17468.53,100,MS-DRG,13974.824,other,100% UHC DRG rate for inpatient setting,17468.53,100,MS-DRG,13974.824,other,100% UHC DRG rate for inpatient setting,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5138.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20103.98,100,MS-DRG,16083.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5037.82,26135.17,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17349.36,130,MS-DRG,13879.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3763.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3763.97,100,,3011.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3952.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10226.25,100,MS-DRG,8181,other,100% UHC DRG rate for inpatient setting,10226.25,100,MS-DRG,8181,other,100% UHC DRG rate for inpatient setting,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3839.25,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13345.66,100,MS-DRG,10676.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3763.97,17349.36,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13874.97,130,MS-DRG,11099.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2848.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2848.21,100,,2278.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2990.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7362.27,100,MS-DRG,5889.816,other,100% UHC DRG rate for inpatient setting,7362.27,100,MS-DRG,5889.816,other,100% UHC DRG rate for inpatient setting,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2905.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10673.05,100,MS-DRG,8538.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2848.21,13874.97,
DYSEQUILIBRIUM,149,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12419.37,130,MS-DRG,9935.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2511.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2511.06,100,,2008.848,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2636.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6162.39,100,MS-DRG,4929.912,other,100% UHC DRG rate for inpatient setting,6162.39,100,MS-DRG,4929.912,other,100% UHC DRG rate for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2561.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2511.06,12419.37,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18139.39,130,MS-DRG,14511.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3115.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3115.84,100,,2492.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3271.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10877.49,100,MS-DRG,8701.992,other,100% UHC DRG rate for inpatient setting,10877.49,100,MS-DRG,8701.992,other,100% UHC DRG rate for inpatient setting,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3178.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13953.38,100,MS-DRG,11162.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3115.84,18139.39,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12680.36,130,MS-DRG,10144.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1907.4,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1907.4,100,,1525.92,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2002.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6377.54,100,MS-DRG,5102.032,other,100% UHC DRG rate for inpatient setting,6377.54,100,MS-DRG,5102.032,other,100% UHC DRG rate for inpatient setting,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1945.55,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9754.12,100,MS-DRG,7803.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1907.4,12680.36,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16871.5,130,MS-DRG,13497.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2823.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2823.17,100,,2258.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2964.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9832.36,100,MS-DRG,7865.888,other,100% UHC DRG rate for inpatient setting,9832.36,100,MS-DRG,7865.888,other,100% UHC DRG rate for inpatient setting,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2879.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12978.08,100,MS-DRG,10382.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2823.17,16871.5,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12319.97,130,MS-DRG,9855.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2407.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2407.15,100,,1925.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2527.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6080.47,100,MS-DRG,4864.376,other,100% UHC DRG rate for inpatient setting,6080.47,100,MS-DRG,4864.376,other,100% UHC DRG rate for inpatient setting,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2455.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9476.9,100,MS-DRG,7581.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2407.15,12319.97,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20385.04,130,MS-DRG,16308.032,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4024.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4024.13,100,,3219.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4225.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12728.61,100,MS-DRG,10182.888,other,100% UHC DRG rate for inpatient setting,12728.61,100,MS-DRG,10182.888,other,100% UHC DRG rate for inpatient setting,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4104.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15680.8,100,MS-DRG,12544.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4024.13,20385.04,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14446.16,130,MS-DRG,11556.928,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2545.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2545.45,100,,2036.36,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2672.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7833.12,100,MS-DRG,6266.496,other,100% UHC DRG rate for inpatient setting,7833.12,100,MS-DRG,6266.496,other,100% UHC DRG rate for inpatient setting,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2596.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11112.43,100,MS-DRG,8889.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2545.45,14446.16,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11523.92,130,MS-DRG,9219.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2018.42,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2018.42,100,,1614.736,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2119.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5424.26,100,MS-DRG,4339.408,other,100% UHC DRG rate for inpatient setting,5424.26,100,MS-DRG,4339.408,other,100% UHC DRG rate for inpatient setting,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2058.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8864.55,100,MS-DRG,7091.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2018.42,11523.92,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22079.55,130,MS-DRG,17663.64,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3906.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3906.01,100,,3124.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4101.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14125.43,100,MS-DRG,11300.344,other,100% UHC DRG rate for inpatient setting,14125.43,100,MS-DRG,11300.344,other,100% UHC DRG rate for inpatient setting,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3984.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16984.27,100,MS-DRG,13587.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3906.01,22079.55,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14364.84,130,MS-DRG,11491.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3457.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3457.47,100,,2765.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3630.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7766.09,100,MS-DRG,6212.872,other,100% UHC DRG rate for inpatient setting,7766.09,100,MS-DRG,6212.872,other,100% UHC DRG rate for inpatient setting,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3526.62,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11049.88,100,MS-DRG,8839.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3457.47,14364.84,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11721.67,130,MS-DRG,9377.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2699.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2699.82,100,,2159.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2834.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5587.28,100,MS-DRG,4469.824,other,100% UHC DRG rate for inpatient setting,5587.28,100,MS-DRG,4469.824,other,100% UHC DRG rate for inpatient setting,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2753.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9016.67,100,MS-DRG,7213.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2699.82,11721.67,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,52261.79,130,MS-DRG,41809.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21275.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,21275.24,100,,17020.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22339,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39005.04,100,MS-DRG,31204.032,other,100% UHC DRG rate for inpatient setting,39005.04,100,MS-DRG,31204.032,other,100% UHC DRG rate for inpatient setting,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21700.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,40201.38,100,MS-DRG,32161.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21275.24,52261.79,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30546.15,130,MS-DRG,24436.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9867.44,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9867.44,100,,7893.952,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10360.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21104.56,100,MS-DRG,16883.648,other,100% UHC DRG rate for inpatient setting,21104.56,100,MS-DRG,16883.648,other,100% UHC DRG rate for inpatient setting,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10064.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23497.04,100,MS-DRG,18797.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9867.44,30546.15,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23780.09,130,MS-DRG,19024.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6730.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6730.67,100,,5384.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7067.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15527.21,100,MS-DRG,12421.768,other,100% UHC DRG rate for inpatient setting,15527.21,100,MS-DRG,12421.768,other,100% UHC DRG rate for inpatient setting,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6865.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18292.38,100,MS-DRG,14633.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6730.67,23780.09,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,45678.44,130,MS-DRG,36542.752,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15620.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15620.31,100,,12496.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16401.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33578.3,100,MS-DRG,26862.64,other,100% UHC DRG rate for inpatient setting,33578.3,100,MS-DRG,26862.64,other,100% UHC DRG rate for inpatient setting,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15932.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35137.26,100,MS-DRG,28109.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15620.31,45678.44,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23211.92,130,MS-DRG,18569.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7210.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7210.61,100,,5768.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7571.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15058.85,100,MS-DRG,12047.08,other,100% UHC DRG rate for inpatient setting,15058.85,100,MS-DRG,12047.08,other,100% UHC DRG rate for inpatient setting,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7354.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17855.32,100,MS-DRG,14284.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7210.61,23211.92,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18552.98,130,MS-DRG,14842.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4988.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4988.11,100,,3990.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5237.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11218.42,100,MS-DRG,8974.736,other,100% UHC DRG rate for inpatient setting,11218.42,100,MS-DRG,8974.736,other,100% UHC DRG rate for inpatient setting,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5087.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14271.52,100,MS-DRG,11417.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4988.11,18552.98,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35812.44,130,MS-DRG,28649.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4396.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4396.04,100,,3516.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4615.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25445.63,100,MS-DRG,20356.504,other,100% UHC DRG rate for inpatient setting,25445.63,100,MS-DRG,20356.504,other,100% UHC DRG rate for inpatient setting,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4483.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27548.03,100,MS-DRG,22038.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4396.04,35812.44,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19027.8,130,MS-DRG,15222.24,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5920.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5920.69,100,,4736.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6216.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11609.83,100,MS-DRG,9287.864,other,100% UHC DRG rate for inpatient setting,11609.83,100,MS-DRG,9287.864,other,100% UHC DRG rate for inpatient setting,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6039.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14636.77,100,MS-DRG,11709.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5920.69,19027.8,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13131.09,130,MS-DRG,10504.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3618.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3618.57,100,,2894.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3799.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6749.09,100,MS-DRG,5399.272,other,100% UHC DRG rate for inpatient setting,6749.09,100,MS-DRG,5399.272,other,100% UHC DRG rate for inpatient setting,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3690.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10100.84,100,MS-DRG,8080.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3618.57,13131.09,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21973.15,130,MS-DRG,17578.52,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7155.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7155.29,100,,5724.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7513.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14037.71,100,MS-DRG,11230.168,other,100% UHC DRG rate for inpatient setting,14037.71,100,MS-DRG,11230.168,other,100% UHC DRG rate for inpatient setting,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7298.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16902.42,100,MS-DRG,13521.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7155.29,21973.15,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14848.72,130,MS-DRG,11878.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5511.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5511.03,100,,4408.824,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5786.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8164.94,100,MS-DRG,6531.952,other,100% UHC DRG rate for inpatient setting,8164.94,100,MS-DRG,6531.952,other,100% UHC DRG rate for inpatient setting,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5621.25,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11422.09,100,MS-DRG,9137.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5511.03,14848.72,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12606.09,130,MS-DRG,10084.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2718.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2718.51,100,,2174.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2854.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6316.31,100,MS-DRG,5053.048,other,100% UHC DRG rate for inpatient setting,6316.31,100,MS-DRG,5053.048,other,100% UHC DRG rate for inpatient setting,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2772.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9696.99,100,MS-DRG,7757.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2718.51,12606.09,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22392.77,130,MS-DRG,17914.216,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6662.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6662.65,100,,5330.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6995.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14383.61,100,MS-DRG,11506.888,other,100% UHC DRG rate for inpatient setting,14383.61,100,MS-DRG,11506.888,other,100% UHC DRG rate for inpatient setting,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6795.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17225.21,100,MS-DRG,13780.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6662.65,22392.77,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15997.14,130,MS-DRG,12797.712,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4964.19,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4964.19,100,,3971.352,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5212.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9111.6,100,MS-DRG,7289.28,other,100% UHC DRG rate for inpatient setting,9111.6,100,MS-DRG,7289.28,other,100% UHC DRG rate for inpatient setting,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5063.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12305.49,100,MS-DRG,9844.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4964.19,15997.14,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12962.46,130,MS-DRG,10369.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2831.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2831.76,100,,2265.408,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2973.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6280.73,100,MS-DRG,5024.584,other,100% UHC DRG rate for inpatient setting,6280.73,100,MS-DRG,5024.584,other,100% UHC DRG rate for inpatient setting,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2888.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9971.12,100,MS-DRG,7976.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2831.76,12962.46,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20749.44,130,MS-DRG,16599.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4907,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4907,100,,3925.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5152.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13028.99,100,MS-DRG,10423.192,other,100% UHC DRG rate for inpatient setting,13028.99,100,MS-DRG,10423.192,other,100% UHC DRG rate for inpatient setting,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5005.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15961.11,100,MS-DRG,12768.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4907,20749.44,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15503.24,130,MS-DRG,12402.592,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3117.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3117.71,100,,2494.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3273.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8704.47,100,MS-DRG,6963.576,other,100% UHC DRG rate for inpatient setting,8704.47,100,MS-DRG,6963.576,other,100% UHC DRG rate for inpatient setting,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3180.06,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11925.57,100,MS-DRG,9540.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3117.71,15503.24,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12529.79,130,MS-DRG,10023.832,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1927.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1927.59,100,,1542.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2023.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6253.42,100,MS-DRG,5002.736,other,100% UHC DRG rate for inpatient setting,6253.42,100,MS-DRG,5002.736,other,100% UHC DRG rate for inpatient setting,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1966.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9638.3,100,MS-DRG,7710.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1927.59,12529.79,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20524.56,130,MS-DRG,16419.648,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6088.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6088.89,100,,4871.112,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6393.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12843.63,100,MS-DRG,10274.904,other,100% UHC DRG rate for inpatient setting,12843.63,100,MS-DRG,10274.904,other,100% UHC DRG rate for inpatient setting,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6210.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15788.12,100,MS-DRG,12630.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6088.89,20524.56,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14945.09,130,MS-DRG,11956.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4338.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4338.1,100,,3470.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4555.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8244.38,100,MS-DRG,6595.504,other,100% UHC DRG rate for inpatient setting,8244.38,100,MS-DRG,6595.504,other,100% UHC DRG rate for inpatient setting,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4424.86,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11496.22,100,MS-DRG,9196.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4338.1,14945.09,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12437.44,130,MS-DRG,9949.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2420.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2420.61,100,,1936.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2541.64,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6177.29,100,MS-DRG,4941.832,other,100% UHC DRG rate for inpatient setting,6177.29,100,MS-DRG,4941.832,other,100% UHC DRG rate for inpatient setting,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2469.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9567.26,100,MS-DRG,7653.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2420.61,12437.44,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17311.22,130,MS-DRG,13848.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5243.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5243.77,100,,4195.016,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5505.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10194.8,100,MS-DRG,8155.84,other,100% UHC DRG rate for inpatient setting,10194.8,100,MS-DRG,8155.84,other,100% UHC DRG rate for inpatient setting,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5348.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13316.32,100,MS-DRG,10653.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5243.77,17311.22,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16006.16,130,MS-DRG,12804.928,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4186.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4186.72,100,,3349.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4396.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9119.05,100,MS-DRG,7295.24,other,100% UHC DRG rate for inpatient setting,9119.05,100,MS-DRG,7295.24,other,100% UHC DRG rate for inpatient setting,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4270.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12312.43,100,MS-DRG,9849.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4186.72,16006.16,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13466.4,130,MS-DRG,10773.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3351.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3351.69,100,,2681.352,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3519.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7025.48,100,MS-DRG,5620.384,other,100% UHC DRG rate for inpatient setting,7025.48,100,MS-DRG,5620.384,other,100% UHC DRG rate for inpatient setting,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3418.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10358.77,100,MS-DRG,8287.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3351.69,13466.4,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11386.38,130,MS-DRG,9109.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2629.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2629.18,100,,2103.344,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2760.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5310.9,100,MS-DRG,4248.72,other,100% UHC DRG rate for inpatient setting,5310.9,100,MS-DRG,4248.72,other,100% UHC DRG rate for inpatient setting,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2681.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8758.75,100,MS-DRG,7007,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2629.18,11386.38,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18260.85,130,MS-DRG,14608.68,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5022.87,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5022.87,100,,4018.296,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5274.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10977.62,100,MS-DRG,8782.096,other,100% UHC DRG rate for inpatient setting,10977.62,100,MS-DRG,8782.096,other,100% UHC DRG rate for inpatient setting,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5123.33,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14046.81,100,MS-DRG,11237.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5022.87,18260.85,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13197.35,130,MS-DRG,10557.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3476.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3476.54,100,,2781.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3650.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6803.71,100,MS-DRG,5442.968,other,100% UHC DRG rate for inpatient setting,6803.71,100,MS-DRG,5442.968,other,100% UHC DRG rate for inpatient setting,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3546.07,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10151.81,100,MS-DRG,8121.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3476.54,13197.35,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11223.76,130,MS-DRG,8979.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2620.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2620.95,100,,2096.76,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2752,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5176.84,100,MS-DRG,4141.472,other,100% UHC DRG rate for inpatient setting,5176.84,100,MS-DRG,4141.472,other,100% UHC DRG rate for inpatient setting,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2673.37,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8633.66,100,MS-DRG,6906.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2620.95,11223.76,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23970.84,130,MS-DRG,19176.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4858.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4858.41,100,,3886.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5101.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15684.44,100,MS-DRG,12547.552,other,100% UHC DRG rate for inpatient setting,15684.44,100,MS-DRG,12547.552,other,100% UHC DRG rate for inpatient setting,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4955.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18439.11,100,MS-DRG,14751.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4858.41,23970.84,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14957.14,130,MS-DRG,11965.712,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3820.42,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3820.42,100,,3056.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4011.44,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8254.31,100,MS-DRG,6603.448,other,100% UHC DRG rate for inpatient setting,8254.31,100,MS-DRG,6603.448,other,100% UHC DRG rate for inpatient setting,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3896.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11505.49,100,MS-DRG,9204.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3820.42,14957.14,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12755.67,130,MS-DRG,10204.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2535.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2535.36,100,,2028.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2662.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6439.61,100,MS-DRG,5151.688,other,100% UHC DRG rate for inpatient setting,6439.61,100,MS-DRG,5151.688,other,100% UHC DRG rate for inpatient setting,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2586.06,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9812.05,100,MS-DRG,7849.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2535.36,12755.67,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22753.16,130,MS-DRG,18202.528,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5659.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5659.79,100,,4527.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5942.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14680.68,100,MS-DRG,11744.544,other,100% UHC DRG rate for inpatient setting,14680.68,100,MS-DRG,11744.544,other,100% UHC DRG rate for inpatient setting,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5772.99,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17502.43,100,MS-DRG,14001.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5659.79,22753.16,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15755.21,130,MS-DRG,12604.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2849.33,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2849.33,100,,2279.464,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2991.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8912.18,100,MS-DRG,7129.744,other,100% UHC DRG rate for inpatient setting,8912.18,100,MS-DRG,7129.744,other,100% UHC DRG rate for inpatient setting,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2906.32,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12119.39,100,MS-DRG,9695.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2849.33,15755.21,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12031.86,130,MS-DRG,9625.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2304.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2304.36,100,,1843.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2419.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5842.98,100,MS-DRG,4674.384,other,100% UHC DRG rate for inpatient setting,5842.98,100,MS-DRG,4674.384,other,100% UHC DRG rate for inpatient setting,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2350.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9255.28,100,MS-DRG,7404.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2304.36,12031.86,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14555.59,130,MS-DRG,11644.472,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3233.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3233.21,100,,2586.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3394.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7923.31,100,MS-DRG,6338.648,other,100% UHC DRG rate for inpatient setting,7923.31,100,MS-DRG,6338.648,other,100% UHC DRG rate for inpatient setting,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3297.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11196.61,100,MS-DRG,8957.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3233.21,14555.59,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11919.44,130,MS-DRG,9535.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2317.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2317.82,100,,1854.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2433.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5750.3,100,MS-DRG,4600.24,other,100% UHC DRG rate for inpatient setting,5750.3,100,MS-DRG,4600.24,other,100% UHC DRG rate for inpatient setting,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2364.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9168.8,100,MS-DRG,7335.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2317.82,11919.44,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13204.39,130,MS-DRG,10563.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2979.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2979.41,100,,2383.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3128.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6809.5,100,MS-DRG,5447.6,other,100% UHC DRG rate for inpatient setting,6809.5,100,MS-DRG,5447.6,other,100% UHC DRG rate for inpatient setting,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3039,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10157.22,100,MS-DRG,8125.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2979.41,13204.39,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23116.56,130,MS-DRG,18493.248,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4377.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4377.72,100,,3502.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4596.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14980.23,100,MS-DRG,11984.184,other,100% UHC DRG rate for inpatient setting,14980.23,100,MS-DRG,11984.184,other,100% UHC DRG rate for inpatient setting,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4465.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17781.97,100,MS-DRG,14225.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4377.72,23116.56,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14113.89,130,MS-DRG,11291.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2569,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2569,100,,2055.2,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2697.45,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7559.21,100,MS-DRG,6047.368,other,100% UHC DRG rate for inpatient setting,7559.21,100,MS-DRG,6047.368,other,100% UHC DRG rate for inpatient setting,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2620.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10856.84,100,MS-DRG,8685.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2569,14113.89,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,74290.59,130,MS-DRG,59432.472,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26113.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,26113.84,100,,20891.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27419.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57163.7,100,MS-DRG,45730.96,other,100% UHC DRG rate for inpatient setting,57163.7,100,MS-DRG,45730.96,other,100% UHC DRG rate for inpatient setting,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26636.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,57146.61,100,MS-DRG,45717.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26113.84,74290.59,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32086.11,130,MS-DRG,25668.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7947.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7947.71,100,,6358.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8345.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22373.95,100,MS-DRG,17899.16,other,100% UHC DRG rate for inpatient setting,22373.95,100,MS-DRG,17899.16,other,100% UHC DRG rate for inpatient setting,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8106.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24681.62,100,MS-DRG,19745.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7947.71,32086.11,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,113066.92,130,MS-DRG,90453.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2043.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2043.83,100,,1635.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2146.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,89127.54,100,MS-DRG,71302.032,other,100% UHC DRG rate for inpatient setting,89127.54,100,MS-DRG,71302.032,other,100% UHC DRG rate for inpatient setting,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2084.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,86974.55,100,MS-DRG,69579.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2043.83,113066.92,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,107486.43,130,MS-DRG,85989.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47967.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,47967.69,100,,38374.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50366.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,84527.47,100,MS-DRG,67621.976,other,100% UHC DRG rate for inpatient setting,84527.47,100,MS-DRG,67621.976,other,100% UHC DRG rate for inpatient setting,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,48927.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,82681.87,100,MS-DRG,66145.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47967.69,107486.43,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,102371.75,130,MS-DRG,81897.4,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40136.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,40136.6,100,,32109.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42143.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,80311.36,100,MS-DRG,64249.088,other,100% UHC DRG rate for inpatient setting,80311.36,100,MS-DRG,64249.088,other,100% UHC DRG rate for inpatient setting,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40939.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,78747.5,100,MS-DRG,62998,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40136.6,102371.75,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,68842.62,130,MS-DRG,55074.096,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23504.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,23504.84,100,,18803.872,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24680.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,52672.86,100,MS-DRG,42138.288,other,100% UHC DRG rate for inpatient setting,52672.86,100,MS-DRG,42138.288,other,100% UHC DRG rate for inpatient setting,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23974.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,52955.86,100,MS-DRG,42364.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23504.84,68842.62,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,62130.77,130,MS-DRG,49704.616,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18750.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18750.35,100,,15000.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19687.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47140.19,100,MS-DRG,37712.152,other,100% UHC DRG rate for inpatient setting,47140.19,100,MS-DRG,37712.152,other,100% UHC DRG rate for inpatient setting,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19125.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,47792.9,100,MS-DRG,38234.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18750.35,62130.77,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,82353.66,130,MS-DRG,65882.928,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25976.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,25976.28,100,,20781.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27275.1,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,63810.18,100,MS-DRG,51048.144,other,100% UHC DRG rate for inpatient setting,63810.18,100,MS-DRG,51048.144,other,100% UHC DRG rate for inpatient setting,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26495.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,63348.97,100,MS-DRG,50679.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25976.28,82353.66,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,57592.3,130,MS-DRG,46073.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20763.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20763.16,100,,16610.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21801.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43399.07,100,MS-DRG,34719.256,other,100% UHC DRG rate for inpatient setting,43399.07,100,MS-DRG,34719.256,other,100% UHC DRG rate for inpatient setting,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21178.42,102,,,other,102% GA Medicaid DRG rate for inpatient setting,44301.77,100,MS-DRG,35441.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20763.16,57592.3,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,51609.26,130,MS-DRG,41287.408,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20361.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20361.72,100,,16289.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21379.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38467.17,100,MS-DRG,30773.736,other,100% UHC DRG rate for inpatient setting,38467.17,100,MS-DRG,30773.736,other,100% UHC DRG rate for inpatient setting,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20768.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,39699.43,100,MS-DRG,31759.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20361.72,51609.26,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,55525.34,130,MS-DRG,44420.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21333.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,21333.18,100,,17066.544,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22399.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41695.24,100,MS-DRG,33356.192,other,100% UHC DRG rate for inpatient setting,41695.24,100,MS-DRG,33356.192,other,100% UHC DRG rate for inpatient setting,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21759.84,102,,,other,102% GA Medicaid DRG rate for inpatient setting,42711.8,100,MS-DRG,34169.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21333.18,55525.34,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,36862.48,130,MS-DRG,29489.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13649.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13649.73,100,,10919.784,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14332.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26311.19,100,MS-DRG,21048.952,other,100% UHC DRG rate for inpatient setting,26311.19,100,MS-DRG,21048.952,other,100% UHC DRG rate for inpatient setting,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13922.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28355.75,100,MS-DRG,22684.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13649.73,36862.48,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,86409.27,130,MS-DRG,69127.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24600.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,24600.02,100,,19680.016,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25830.02,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,67153.28,100,MS-DRG,53722.624,other,100% UHC DRG rate for inpatient setting,67153.28,100,MS-DRG,53722.624,other,100% UHC DRG rate for inpatient setting,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25092.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,66468.67,100,MS-DRG,53174.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24600.02,86409.27,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,64659.52,130,MS-DRG,51727.616,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20802.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20802.41,100,,16641.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21842.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49224.67,100,MS-DRG,39379.736,other,100% UHC DRG rate for inpatient setting,49224.67,100,MS-DRG,39379.736,other,100% UHC DRG rate for inpatient setting,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21218.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,49738.09,100,MS-DRG,39790.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20802.41,64659.52,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,83241.08,130,MS-DRG,66592.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24335.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,24335.01,100,,19468.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25551.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,64541.69,100,MS-DRG,51633.352,other,100% UHC DRG rate for inpatient setting,64541.69,100,MS-DRG,51633.352,other,100% UHC DRG rate for inpatient setting,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24821.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,64031.6,100,MS-DRG,51225.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24335.01,83241.08,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,57123.5,130,MS-DRG,45698.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16910.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,16910.6,100,,13528.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17756.13,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43012.62,100,MS-DRG,34410.096,other,100% UHC DRG rate for inpatient setting,43012.62,100,MS-DRG,34410.096,other,100% UHC DRG rate for inpatient setting,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17248.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,43941.15,100,MS-DRG,35152.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16910.6,57123.5,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,63976.9,130,MS-DRG,51181.52,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20071.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20071.67,100,,16057.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21075.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,48661.97,100,MS-DRG,38929.576,other,100% UHC DRG rate for inpatient setting,48661.97,100,MS-DRG,38929.576,other,100% UHC DRG rate for inpatient setting,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20473.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,49213,100,MS-DRG,39370.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20071.67,63976.9,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,45511.78,130,MS-DRG,36409.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14538.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14538.21,100,,11630.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15265.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33440.93,100,MS-DRG,26752.744,other,100% UHC DRG rate for inpatient setting,33440.93,100,MS-DRG,26752.744,other,100% UHC DRG rate for inpatient setting,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14828.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35009.06,100,MS-DRG,28007.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14538.21,45511.78,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,53197.39,130,MS-DRG,42557.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20707.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20707.84,100,,16566.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21743.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39776.27,100,MS-DRG,31821.016,other,100% UHC DRG rate for inpatient setting,39776.27,100,MS-DRG,31821.016,other,100% UHC DRG rate for inpatient setting,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21122,102,,,other,102% GA Medicaid DRG rate for inpatient setting,40921.07,100,MS-DRG,32736.856,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20707.84,53197.39,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33144.18,130,MS-DRG,26515.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10044.62,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10044.62,100,,8035.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10546.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23246.13,100,MS-DRG,18596.904,other,100% UHC DRG rate for inpatient setting,23246.13,100,MS-DRG,18596.904,other,100% UHC DRG rate for inpatient setting,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10245.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25495.52,100,MS-DRG,20396.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10044.62,33144.18,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18937.46,130,MS-DRG,15149.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4228.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4228.58,100,,3382.864,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4440.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11500.6,100,MS-DRG,9200.48,other,100% UHC DRG rate for inpatient setting,11500.6,100,MS-DRG,9200.48,other,100% UHC DRG rate for inpatient setting,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4313.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14567.28,100,MS-DRG,11653.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4228.58,18937.46,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39628.12,130,MS-DRG,31702.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15900.27,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15900.27,100,,12720.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16695.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28590.95,100,MS-DRG,22872.76,other,100% UHC DRG rate for inpatient setting,28590.95,100,MS-DRG,22872.76,other,100% UHC DRG rate for inpatient setting,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16218.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30483.17,100,MS-DRG,24386.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15900.27,39628.12,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27807.61,130,MS-DRG,22246.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10206.09,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10206.09,100,,8164.872,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10716.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18847.14,100,MS-DRG,15077.712,other,100% UHC DRG rate for inpatient setting,18847.14,100,MS-DRG,15077.712,other,100% UHC DRG rate for inpatient setting,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10410.21,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21390.47,100,MS-DRG,17112.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10206.09,27807.61,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23309.29,130,MS-DRG,18647.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7909.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7909.21,100,,6327.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8304.67,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15139.11,100,MS-DRG,12111.288,other,100% UHC DRG rate for inpatient setting,15139.11,100,MS-DRG,12111.288,other,100% UHC DRG rate for inpatient setting,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8067.39,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17930.22,100,MS-DRG,14344.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7909.21,23309.29,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,50432.73,130,MS-DRG,40346.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18516.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18516.36,100,,14813.088,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19442.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37497.34,100,MS-DRG,29997.872,other,100% UHC DRG rate for inpatient setting,37497.34,100,MS-DRG,29997.872,other,100% UHC DRG rate for inpatient setting,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18886.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38794.41,100,MS-DRG,31035.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18516.36,50432.73,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28542.44,130,MS-DRG,22833.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9114.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9114.28,100,,7291.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9569.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19452.87,100,MS-DRG,15562.296,other,100% UHC DRG rate for inpatient setting,19452.87,100,MS-DRG,15562.296,other,100% UHC DRG rate for inpatient setting,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9296.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21955.72,100,MS-DRG,17564.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9114.28,28542.44,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20873.92,130,MS-DRG,16699.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5576.44,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5576.44,100,,4461.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5855.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13131.6,100,MS-DRG,10505.28,other,100% UHC DRG rate for inpatient setting,13131.6,100,MS-DRG,10505.28,other,100% UHC DRG rate for inpatient setting,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5687.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16056.86,100,MS-DRG,12845.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5576.44,20873.92,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38611.21,130,MS-DRG,30888.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12707.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12707.06,100,,10165.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13342.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27752.7,100,MS-DRG,22202.16,other,100% UHC DRG rate for inpatient setting,27752.7,100,MS-DRG,22202.16,other,100% UHC DRG rate for inpatient setting,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12961.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29700.93,100,MS-DRG,23760.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12707.06,38611.21,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30553.19,130,MS-DRG,24442.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10753.68,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10753.68,100,,8602.944,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11291.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21110.35,100,MS-DRG,16888.28,other,100% UHC DRG rate for inpatient setting,21110.35,100,MS-DRG,16888.28,other,100% UHC DRG rate for inpatient setting,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10968.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23502.45,100,MS-DRG,18801.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10753.68,30553.19,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22361.65,130,MS-DRG,17889.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7070.07,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7070.07,100,,5656.056,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7423.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14357.95,100,MS-DRG,11486.36,other,100% UHC DRG rate for inpatient setting,14357.95,100,MS-DRG,11486.36,other,100% UHC DRG rate for inpatient setting,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7211.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17201.27,100,MS-DRG,13761.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7070.07,22361.65,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32523.76,130,MS-DRG,26019.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5646.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5646.71,100,,4517.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5929.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22734.74,100,MS-DRG,18187.792,other,100% UHC DRG rate for inpatient setting,22734.74,100,MS-DRG,18187.792,other,100% UHC DRG rate for inpatient setting,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5759.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25018.28,100,MS-DRG,20014.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5646.71,32523.76,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21403.95,130,MS-DRG,17123.16,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5517.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5517.76,100,,4414.208,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5793.64,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13568.52,100,MS-DRG,10854.816,other,100% UHC DRG rate for inpatient setting,13568.52,100,MS-DRG,10854.816,other,100% UHC DRG rate for inpatient setting,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5628.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16464.58,100,MS-DRG,13171.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5517.76,21403.95,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14891.89,130,MS-DRG,11913.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2820.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2820.18,100,,2256.144,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2961.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8200.53,100,MS-DRG,6560.424,other,100% UHC DRG rate for inpatient setting,8200.53,100,MS-DRG,6560.424,other,100% UHC DRG rate for inpatient setting,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2876.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11455.3,100,MS-DRG,9164.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2820.18,14891.89,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32134.27,130,MS-DRG,25707.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7961.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7961.54,100,,6369.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8359.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22413.67,100,MS-DRG,17930.936,other,100% UHC DRG rate for inpatient setting,22413.67,100,MS-DRG,17930.936,other,100% UHC DRG rate for inpatient setting,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8120.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24718.67,100,MS-DRG,19774.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7961.54,32134.27,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23681.74,130,MS-DRG,18945.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5570.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5570.83,100,,4456.664,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5849.37,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15446.12,100,MS-DRG,12356.896,other,100% UHC DRG rate for inpatient setting,15446.12,100,MS-DRG,12356.896,other,100% UHC DRG rate for inpatient setting,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5682.25,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18216.72,100,MS-DRG,14573.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5570.83,23681.74,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38223.72,130,MS-DRG,30578.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10650.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10650.89,100,,8520.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11183.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27433.28,100,MS-DRG,21946.624,other,100% UHC DRG rate for inpatient setting,27433.28,100,MS-DRG,21946.624,other,100% UHC DRG rate for inpatient setting,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10863.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29402.86,100,MS-DRG,23522.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10650.89,38223.72,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23834.3,130,MS-DRG,19067.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5534.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5534.95,100,,4427.96,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5811.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15571.9,100,MS-DRG,12457.52,other,100% UHC DRG rate for inpatient setting,15571.9,100,MS-DRG,12457.52,other,100% UHC DRG rate for inpatient setting,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5645.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18334.08,100,MS-DRG,14667.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5534.95,23834.3,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21460.18,130,MS-DRG,17168.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5041.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5041.18,100,,4032.944,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5293.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13614.86,100,MS-DRG,10891.888,other,100% UHC DRG rate for inpatient setting,13614.86,100,MS-DRG,10891.888,other,100% UHC DRG rate for inpatient setting,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5142.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16507.83,100,MS-DRG,13206.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5041.18,21460.18,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33304.79,130,MS-DRG,26643.832,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9833.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9833.06,100,,7866.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10324.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23378.53,100,MS-DRG,18702.824,other,100% UHC DRG rate for inpatient setting,23378.53,100,MS-DRG,18702.824,other,100% UHC DRG rate for inpatient setting,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10029.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25619.07,100,MS-DRG,20495.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9833.06,33304.79,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37729.82,130,MS-DRG,30183.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10242.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10242.72,100,,8194.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10754.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27026.15,100,MS-DRG,21620.92,other,100% UHC DRG rate for inpatient setting,27026.15,100,MS-DRG,21620.92,other,100% UHC DRG rate for inpatient setting,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10447.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29022.94,100,MS-DRG,23218.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10242.72,37729.82,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,40421.19,130,MS-DRG,32336.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9353.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9353.5,100,,7482.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9821.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29244.68,100,MS-DRG,23395.744,other,100% UHC DRG rate for inpatient setting,29244.68,100,MS-DRG,23395.744,other,100% UHC DRG rate for inpatient setting,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9540.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31093.22,100,MS-DRG,24874.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9353.5,40421.19,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,67646.02,130,MS-DRG,54116.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18017.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18017.74,100,,14414.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18918.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51686.48,100,MS-DRG,41349.184,other,100% UHC DRG rate for inpatient setting,51686.48,100,MS-DRG,41349.184,other,100% UHC DRG rate for inpatient setting,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18378.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,52035.4,100,MS-DRG,41628.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18017.74,67646.02,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,53934.22,130,MS-DRG,43147.376,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2057.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2057.29,100,,1645.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2160.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40383.66,100,MS-DRG,32306.928,other,100% UHC DRG rate for inpatient setting,40383.66,100,MS-DRG,32306.928,other,100% UHC DRG rate for inpatient setting,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2098.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,41487.86,100,MS-DRG,33190.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2057.29,53934.22,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,73755.54,130,MS-DRG,59004.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9935.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9935.1,100,,7948.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10431.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56722.64,100,MS-DRG,45378.112,other,100% UHC DRG rate for inpatient setting,56722.64,100,MS-DRG,45378.112,other,100% UHC DRG rate for inpatient setting,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10133.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,56735.03,100,MS-DRG,45388.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9935.1,73755.54,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,46690.33,130,MS-DRG,37352.264,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1675.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1675.29,100,,1340.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1759.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34412.42,100,MS-DRG,27529.936,other,100% UHC DRG rate for inpatient setting,34412.42,100,MS-DRG,27529.936,other,100% UHC DRG rate for inpatient setting,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1708.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35915.64,100,MS-DRG,28732.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1675.29,46690.33,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,55708.04,130,MS-DRG,44566.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1068.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1068.64,100,,854.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1122.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41845.85,100,MS-DRG,33476.68,other,100% UHC DRG rate for inpatient setting,41845.85,100,MS-DRG,33476.68,other,100% UHC DRG rate for inpatient setting,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1090.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,42852.34,100,MS-DRG,34281.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1068.64,55708.04,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39639.17,130,MS-DRG,31711.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2007.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2007.58,100,,1606.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2107.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28600.06,100,MS-DRG,22880.048,other,100% UHC DRG rate for inpatient setting,28600.06,100,MS-DRG,22880.048,other,100% UHC DRG rate for inpatient setting,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2047.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30491.67,100,MS-DRG,24393.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2007.58,39639.17,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29432.86,130,MS-DRG,23546.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20186.86,100,MS-DRG,16149.488,other,100% UHC DRG rate for inpatient setting,20186.86,100,MS-DRG,16149.488,other,100% UHC DRG rate for inpatient setting,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,22640.66,100,MS-DRG,18112.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20186.86,29432.86,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,44064.2,130,MS-DRG,35251.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14559.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14559.52,100,,11647.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15287.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32247.68,100,MS-DRG,25798.144,other,100% UHC DRG rate for inpatient setting,32247.68,100,MS-DRG,25798.144,other,100% UHC DRG rate for inpatient setting,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14850.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33895.54,100,MS-DRG,27116.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14559.52,44064.2,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37476.84,130,MS-DRG,29981.472,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7736.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7736.89,100,,6189.512,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8123.74,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26817.62,100,MS-DRG,21454.096,other,100% UHC DRG rate for inpatient setting,26817.62,100,MS-DRG,21454.096,other,100% UHC DRG rate for inpatient setting,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7891.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28828.34,100,MS-DRG,23062.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7736.89,37476.84,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,75573.55,130,MS-DRG,60458.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18711.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18711.1,100,,14968.88,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19646.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,58221.25,100,MS-DRG,46577,other,100% UHC DRG rate for inpatient setting,58221.25,100,MS-DRG,46577,other,100% UHC DRG rate for inpatient setting,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19085.33,102,,,other,102% GA Medicaid DRG rate for inpatient setting,58133.5,100,MS-DRG,46506.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18711.1,75573.55,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC,276,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,67285.62,130,MS-DRG,53828.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13372.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13372.02,100,,10697.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14040.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51389.41,100,MS-DRG,41111.528,other,100% UHC DRG rate for inpatient setting,51389.41,100,MS-DRG,41111.528,other,100% UHC DRG rate for inpatient setting,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13639.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51758.17,100,MS-DRG,41406.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13372.02,67285.62,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,52952.45,130,MS-DRG,42361.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20184.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20184.55,100,,16147.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21193.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39574.36,100,MS-DRG,31659.488,other,100% UHC DRG rate for inpatient setting,39574.36,100,MS-DRG,31659.488,other,100% UHC DRG rate for inpatient setting,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20588.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,40732.65,100,MS-DRG,32586.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20184.55,52952.45,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,49720,130,MS-DRG,39776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13330.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13330.15,100,,10664.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13996.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36909.81,100,MS-DRG,29527.848,other,100% UHC DRG rate for inpatient setting,36909.81,100,MS-DRG,29527.848,other,100% UHC DRG rate for inpatient setting,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13596.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38246.15,100,MS-DRG,30596.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13330.15,49720,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37073.3,130,MS-DRG,29658.64,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8399.23,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8399.23,100,,6719.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8819.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26484.97,100,MS-DRG,21187.976,other,100% UHC DRG rate for inpatient setting,26484.97,100,MS-DRG,21187.976,other,100% UHC DRG rate for inpatient setting,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8567.22,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28517.92,100,MS-DRG,22814.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8399.23,37073.3,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20869.9,130,MS-DRG,16695.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6219.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6219.34,100,,4975.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6530.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13128.29,100,MS-DRG,10502.632,other,100% UHC DRG rate for inpatient setting,13128.29,100,MS-DRG,10502.632,other,100% UHC DRG rate for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6343.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6219.34,20869.9,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14108.87,130,MS-DRG,11287.096,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3679.87,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3679.87,100,,2943.896,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3863.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7555.08,100,MS-DRG,6044.064,other,100% UHC DRG rate for inpatient setting,7555.08,100,MS-DRG,6044.064,other,100% UHC DRG rate for inpatient setting,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3753.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10852.98,100,MS-DRG,8682.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3679.87,14108.87,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12152.34,130,MS-DRG,9721.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3679.87,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3679.87,100,,2943.896,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3863.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5942.28,100,MS-DRG,4753.824,other,100% UHC DRG rate for inpatient setting,5942.28,100,MS-DRG,4753.824,other,100% UHC DRG rate for inpatient setting,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3753.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9347.95,100,MS-DRG,7478.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3679.87,12152.34,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24733.77,130,MS-DRG,19787.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4654.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4654.69,100,,3723.752,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4887.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16313.34,100,MS-DRG,13050.672,other,100% UHC DRG rate for inpatient setting,16313.34,100,MS-DRG,13050.672,other,100% UHC DRG rate for inpatient setting,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4747.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19025.98,100,MS-DRG,15220.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4654.69,24733.77,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12369.18,130,MS-DRG,9895.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2211.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2211.29,100,,1769.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2321.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6121.02,100,MS-DRG,4896.816,other,100% UHC DRG rate for inpatient setting,6121.02,100,MS-DRG,4896.816,other,100% UHC DRG rate for inpatient setting,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2255.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9514.75,100,MS-DRG,7611.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2211.29,12369.18,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,9849.46,130,MS-DRG,7879.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2151.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2151.86,100,,1721.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2259.45,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4043.99,100,MS-DRG,3235.192,other,100% UHC DRG rate for inpatient setting,4043.99,100,MS-DRG,3235.192,other,100% UHC DRG rate for inpatient setting,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2194.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,7576.51,100,MS-DRG,6061.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2151.86,9849.46,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26582.91,130,MS-DRG,21266.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9632.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9632.34,100,,7705.872,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10113.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17837.59,100,MS-DRG,14270.072,other,100% UHC DRG rate for inpatient setting,17837.59,100,MS-DRG,14270.072,other,100% UHC DRG rate for inpatient setting,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9824.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20448.39,100,MS-DRG,16358.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9632.34,26582.91,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15801.38,130,MS-DRG,12641.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4981.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4981.75,100,,3985.4,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5230.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8950.24,100,MS-DRG,7160.192,other,100% UHC DRG rate for inpatient setting,8950.24,100,MS-DRG,7160.192,other,100% UHC DRG rate for inpatient setting,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5081.39,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12154.91,100,MS-DRG,9723.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4981.75,15801.38,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30973.8,130,MS-DRG,24779.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7834.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7834.45,100,,6267.56,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8226.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21457.08,100,MS-DRG,17165.664,other,100% UHC DRG rate for inpatient setting,21457.08,100,MS-DRG,17165.664,other,100% UHC DRG rate for inpatient setting,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7991.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23826,100,MS-DRG,19060.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7834.45,30973.8,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19777.71,130,MS-DRG,15822.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5014.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5014.65,100,,4011.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5265.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12227.97,100,MS-DRG,9782.376,other,100% UHC DRG rate for inpatient setting,12227.97,100,MS-DRG,9782.376,other,100% UHC DRG rate for inpatient setting,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5114.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15213.62,100,MS-DRG,12170.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5014.65,19777.71,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15836.52,130,MS-DRG,12669.216,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4588.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4588.54,100,,3670.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4817.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8483.53,100,MS-DRG,6786.824,other,100% UHC DRG rate for inpatient setting,8483.53,100,MS-DRG,6786.824,other,100% UHC DRG rate for inpatient setting,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4680.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12181.94,100,MS-DRG,9745.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4588.54,15836.52,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17832.2,130,MS-DRG,14265.76,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5169.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5169.02,100,,4135.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5427.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10624.27,100,MS-DRG,8499.416,other,100% UHC DRG rate for inpatient setting,10624.27,100,MS-DRG,8499.416,other,100% UHC DRG rate for inpatient setting,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5272.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13717.08,100,MS-DRG,10973.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5169.02,17832.2,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13541.68,130,MS-DRG,10833.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3334.87,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3334.87,100,,2667.896,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3501.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7087.54,100,MS-DRG,5670.032,other,100% UHC DRG rate for inpatient setting,7087.54,100,MS-DRG,5670.032,other,100% UHC DRG rate for inpatient setting,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3401.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10416.68,100,MS-DRG,8333.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3334.87,13541.68,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10580.28,130,MS-DRG,8464.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2314.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2314.83,100,,1851.864,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2430.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4646.41,100,MS-DRG,3717.128,other,100% UHC DRG rate for inpatient setting,4646.41,100,MS-DRG,3717.128,other,100% UHC DRG rate for inpatient setting,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2361.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8138.68,100,MS-DRG,6510.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2314.83,10580.28,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15922.86,130,MS-DRG,12738.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2924.09,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2924.09,100,,2339.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3070.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9050.37,100,MS-DRG,7240.296,other,100% UHC DRG rate for inpatient setting,9050.37,100,MS-DRG,7240.296,other,100% UHC DRG rate for inpatient setting,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2982.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12248.35,100,MS-DRG,9798.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2924.09,15922.86,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12945.39,130,MS-DRG,10356.312,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2924.09,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2924.09,100,,2339.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3070.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5225.66,100,MS-DRG,4180.528,other,100% UHC DRG rate for inpatient setting,5225.66,100,MS-DRG,4180.528,other,100% UHC DRG rate for inpatient setting,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2982.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9957.99,100,MS-DRG,7966.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2924.09,12945.39,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21037.55,130,MS-DRG,16830.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6426.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6426.04,100,,5140.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6747.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13266.48,100,MS-DRG,10613.184,other,100% UHC DRG rate for inpatient setting,13266.48,100,MS-DRG,10613.184,other,100% UHC DRG rate for inpatient setting,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6554.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16182.73,100,MS-DRG,12946.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6426.04,21037.55,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12257.73,130,MS-DRG,9806.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1809.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1809.1,100,,1447.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1899.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6029.17,100,MS-DRG,4823.336,other,100% UHC DRG rate for inpatient setting,6029.17,100,MS-DRG,4823.336,other,100% UHC DRG rate for inpatient setting,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1845.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9429.02,100,MS-DRG,7543.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1809.1,12257.73,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,9357.57,130,MS-DRG,7486.056,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1809.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1809.1,100,,1447.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1899.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3631.9,100,MS-DRG,2905.52,other,100% UHC DRG rate for inpatient setting,3631.9,100,MS-DRG,2905.52,other,100% UHC DRG rate for inpatient setting,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1845.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,7198.13,100,MS-DRG,5758.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1809.1,9357.57,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20766.49,130,MS-DRG,16613.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4686.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4686.47,100,,3749.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4920.79,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13043.06,100,MS-DRG,10434.448,other,100% UHC DRG rate for inpatient setting,13043.06,100,MS-DRG,10434.448,other,100% UHC DRG rate for inpatient setting,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4780.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15974.22,100,MS-DRG,12779.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4686.47,20766.49,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15654.83,130,MS-DRG,12523.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3861.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3861.16,100,,3088.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4054.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8829.43,100,MS-DRG,7063.544,other,100% UHC DRG rate for inpatient setting,8829.43,100,MS-DRG,7063.544,other,100% UHC DRG rate for inpatient setting,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3938.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12042.18,100,MS-DRG,9633.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3861.16,15654.83,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12069.01,130,MS-DRG,9655.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2218.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2218.76,100,,1775.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2329.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5873.6,100,MS-DRG,4698.88,other,100% UHC DRG rate for inpatient setting,5873.6,100,MS-DRG,4698.88,other,100% UHC DRG rate for inpatient setting,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2263.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9283.85,100,MS-DRG,7427.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2218.76,12069.01,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16197.91,130,MS-DRG,12958.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2775.32,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2775.32,100,,2220.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2914.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9277.1,100,MS-DRG,7421.68,other,100% UHC DRG rate for inpatient setting,9277.1,100,MS-DRG,7421.68,other,100% UHC DRG rate for inpatient setting,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2830.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12459.93,100,MS-DRG,9967.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2775.32,16197.91,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11550.02,130,MS-DRG,9240.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2665.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2665.06,100,,2132.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2798.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5445.78,100,MS-DRG,4356.624,other,100% UHC DRG rate for inpatient setting,5445.78,100,MS-DRG,4356.624,other,100% UHC DRG rate for inpatient setting,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2718.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8884.63,100,MS-DRG,7107.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2665.06,11550.02,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16477.99,130,MS-DRG,13182.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3302.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3302.73,100,,2642.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3467.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9507.98,100,MS-DRG,7606.384,other,100% UHC DRG rate for inpatient setting,9507.98,100,MS-DRG,7606.384,other,100% UHC DRG rate for inpatient setting,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3368.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12675.38,100,MS-DRG,10140.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3302.73,16477.99,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12507.72,130,MS-DRG,10006.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2702.81,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2702.81,100,,2162.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2837.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6235.21,100,MS-DRG,4988.168,other,100% UHC DRG rate for inpatient setting,6235.21,100,MS-DRG,4988.168,other,100% UHC DRG rate for inpatient setting,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2756.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9621.32,100,MS-DRG,7697.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2702.81,12507.72,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20370.99,130,MS-DRG,16296.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3356.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3356.55,100,,2685.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3524.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12717.02,100,MS-DRG,10173.616,other,100% UHC DRG rate for inpatient setting,12717.02,100,MS-DRG,10173.616,other,100% UHC DRG rate for inpatient setting,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3423.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15669.99,100,MS-DRG,12535.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3356.55,20370.99,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14406,130,MS-DRG,11524.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2607.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2607.12,100,,2085.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2737.48,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7800.02,100,MS-DRG,6240.016,other,100% UHC DRG rate for inpatient setting,7800.02,100,MS-DRG,6240.016,other,100% UHC DRG rate for inpatient setting,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2659.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11081.54,100,MS-DRG,8865.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2607.12,14406,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17012.05,130,MS-DRG,13609.64,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5034.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5034.83,100,,4027.864,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5286.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9948.21,100,MS-DRG,7958.568,other,100% UHC DRG rate for inpatient setting,9948.21,100,MS-DRG,7958.568,other,100% UHC DRG rate for inpatient setting,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5135.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13086.19,100,MS-DRG,10468.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5034.83,17012.05,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12419.37,130,MS-DRG,9935.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3221.99,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3221.99,100,,2577.592,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3383.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6162.39,100,MS-DRG,4929.912,other,100% UHC DRG rate for inpatient setting,6162.39,100,MS-DRG,4929.912,other,100% UHC DRG rate for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3286.43,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9553.36,100,MS-DRG,7642.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3221.99,12419.37,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10494.97,130,MS-DRG,8395.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2179.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2179.52,100,,1743.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2288.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4576.08,100,MS-DRG,3660.864,other,100% UHC DRG rate for inpatient setting,4576.08,100,MS-DRG,3660.864,other,100% UHC DRG rate for inpatient setting,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2223.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8073.05,100,MS-DRG,6458.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2179.52,10494.97,
ANGINA PECTORIS,311,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11951.56,130,MS-DRG,9561.248,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2731.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2731.97,100,,2185.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2868.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5776.78,100,MS-DRG,4621.424,other,100% UHC DRG rate for inpatient setting,5776.78,100,MS-DRG,4621.424,other,100% UHC DRG rate for inpatient setting,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2786.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9193.51,100,MS-DRG,7354.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2731.97,11951.56,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13611.96,130,MS-DRG,10889.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2852.7,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2852.7,100,,2282.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2995.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7145.46,100,MS-DRG,5716.368,other,100% UHC DRG rate for inpatient setting,7145.46,100,MS-DRG,5716.368,other,100% UHC DRG rate for inpatient setting,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2909.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10470.74,100,MS-DRG,8376.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2852.7,13611.96,
CHEST PAIN,313,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12207.55,130,MS-DRG,9766.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2794.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2794.76,100,,2235.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2934.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5987.79,100,MS-DRG,4790.232,other,100% UHC DRG rate for inpatient setting,5987.79,100,MS-DRG,4790.232,other,100% UHC DRG rate for inpatient setting,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2850.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9390.42,100,MS-DRG,7512.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2794.76,12207.55,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25959.49,130,MS-DRG,20767.592,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8716.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8716.57,100,,6973.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9152.4,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17323.71,100,MS-DRG,13858.968,other,100% UHC DRG rate for inpatient setting,17323.71,100,MS-DRG,13858.968,other,100% UHC DRG rate for inpatient setting,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8890.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19968.84,100,MS-DRG,15975.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8716.57,25959.49,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14653.98,130,MS-DRG,11723.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4286.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4286.52,100,,3429.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4500.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8004.41,100,MS-DRG,6403.528,other,100% UHC DRG rate for inpatient setting,8004.41,100,MS-DRG,6403.528,other,100% UHC DRG rate for inpatient setting,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4372.25,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11272.29,100,MS-DRG,9017.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4286.52,14653.98,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11897.35,130,MS-DRG,9517.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3284.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3284.04,100,,2627.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3448.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5732.09,100,MS-DRG,4585.672,other,100% UHC DRG rate for inpatient setting,5732.09,100,MS-DRG,4585.672,other,100% UHC DRG rate for inpatient setting,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3349.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9151.81,100,MS-DRG,7321.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3284.04,11897.35,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,48731.19,130,MS-DRG,38984.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36094.72,100,MS-DRG,28875.776,other,100% UHC DRG rate for inpatient setting,36094.72,100,MS-DRG,28875.776,other,100% UHC DRG rate for inpatient setting,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,37485.53,100,MS-DRG,29988.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36094.72,48731.19,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27289.61,130,MS-DRG,21831.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18420.15,100,MS-DRG,14736.12,other,100% UHC DRG rate for inpatient setting,18420.15,100,MS-DRG,14736.12,other,100% UHC DRG rate for inpatient setting,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,20992.01,100,MS-DRG,16793.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18420.15,27289.61,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33801.69,130,MS-DRG,27041.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23788.14,100,MS-DRG,19030.512,other,100% UHC DRG rate for inpatient setting,23788.14,100,MS-DRG,19030.512,other,100% UHC DRG rate for inpatient setting,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,26001.3,100,MS-DRG,20801.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23788.14,33801.69,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23248.06,130,MS-DRG,18598.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15088.64,100,MS-DRG,12070.912,other,100% UHC DRG rate for inpatient setting,15088.64,100,MS-DRG,12070.912,other,100% UHC DRG rate for inpatient setting,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,17883.12,100,MS-DRG,14306.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15088.64,23248.06,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,46503.61,130,MS-DRG,37202.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34258.5,100,MS-DRG,27406.8,other,100% UHC DRG rate for inpatient setting,34258.5,100,MS-DRG,27406.8,other,100% UHC DRG rate for inpatient setting,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,35772.01,100,MS-DRG,28617.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34258.5,46503.61,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34744.33,130,MS-DRG,27795.464,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24565.17,100,MS-DRG,19652.136,other,100% UHC DRG rate for inpatient setting,24565.17,100,MS-DRG,19652.136,other,100% UHC DRG rate for inpatient setting,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,26726.41,100,MS-DRG,21381.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24565.17,34744.33,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31488.78,130,MS-DRG,25191.024,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21881.58,100,MS-DRG,17505.264,other,100% UHC DRG rate for inpatient setting,21881.58,100,MS-DRG,17505.264,other,100% UHC DRG rate for inpatient setting,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,24222.14,100,MS-DRG,19377.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21881.58,31488.78,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,55929.9,130,MS-DRG,44743.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17477.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,17477.63,100,,13982.104,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18351.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42028.73,100,MS-DRG,33622.984,other,100% UHC DRG rate for inpatient setting,42028.73,100,MS-DRG,33622.984,other,100% UHC DRG rate for inpatient setting,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17827.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,43023,100,MS-DRG,34418.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17477.63,55929.9,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30014.13,130,MS-DRG,24011.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8742.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8742.74,100,,6994.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9179.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20665.99,100,MS-DRG,16532.792,other,100% UHC DRG rate for inpatient setting,20665.99,100,MS-DRG,16532.792,other,100% UHC DRG rate for inpatient setting,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8917.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23087.79,100,MS-DRG,18470.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8742.74,30014.13,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20978.32,130,MS-DRG,16782.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5315.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5315.91,100,,4252.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5581.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13217.66,100,MS-DRG,10574.128,other,100% UHC DRG rate for inpatient setting,13217.66,100,MS-DRG,10574.128,other,100% UHC DRG rate for inpatient setting,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5422.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16137.17,100,MS-DRG,12909.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5315.91,20978.32,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,50286.17,130,MS-DRG,40228.936,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18224.81,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18224.81,100,,14579.848,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19136.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37376.52,100,MS-DRG,29901.216,other,100% UHC DRG rate for inpatient setting,37376.52,100,MS-DRG,29901.216,other,100% UHC DRG rate for inpatient setting,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18589.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38681.67,100,MS-DRG,30945.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18224.81,50286.17,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28756.27,130,MS-DRG,23005.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9443.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9443.95,100,,7555.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9916.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19629.13,100,MS-DRG,15703.304,other,100% UHC DRG rate for inpatient setting,19629.13,100,MS-DRG,15703.304,other,100% UHC DRG rate for inpatient setting,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9632.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22120.21,100,MS-DRG,17696.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9443.95,28756.27,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21728.21,130,MS-DRG,17382.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6301.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6301.57,100,,5041.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6616.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13835.8,100,MS-DRG,11068.64,other,100% UHC DRG rate for inpatient setting,13835.8,100,MS-DRG,11068.64,other,100% UHC DRG rate for inpatient setting,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6427.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16714.01,100,MS-DRG,13371.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6301.57,21728.21,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41627.82,130,MS-DRG,33302.256,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13373.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13373.51,100,,10698.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14042.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30018.39,100,MS-DRG,24014.712,other,100% UHC DRG rate for inpatient setting,30018.39,100,MS-DRG,24014.712,other,100% UHC DRG rate for inpatient setting,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13640.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32021.4,100,MS-DRG,25617.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13373.51,41627.82,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25818.95,130,MS-DRG,20655.16,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7359.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7359.75,100,,5887.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7727.74,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17207.86,100,MS-DRG,13766.288,other,100% UHC DRG rate for inpatient setting,17207.86,100,MS-DRG,13766.288,other,100% UHC DRG rate for inpatient setting,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7506.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19860.73,100,MS-DRG,15888.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7359.75,25818.95,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21056.61,130,MS-DRG,16845.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5700.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5700.16,100,,4560.128,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5985.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13282.2,100,MS-DRG,10625.76,other,100% UHC DRG rate for inpatient setting,13282.2,100,MS-DRG,10625.76,other,100% UHC DRG rate for inpatient setting,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5814.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16197.39,100,MS-DRG,12957.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5700.16,21056.61,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,40831.77,130,MS-DRG,32665.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18121.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18121.28,100,,14497.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19027.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29583.13,100,MS-DRG,23666.504,other,100% UHC DRG rate for inpatient setting,29583.13,100,MS-DRG,23666.504,other,100% UHC DRG rate for inpatient setting,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18483.7,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31409.05,100,MS-DRG,25127.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18121.28,40831.77,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26077.96,130,MS-DRG,20862.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9208.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9208.84,100,,7367.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9669.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17421.36,100,MS-DRG,13937.088,other,100% UHC DRG rate for inpatient setting,17421.36,100,MS-DRG,13937.088,other,100% UHC DRG rate for inpatient setting,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9393.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20059.97,100,MS-DRG,16047.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9208.84,26077.96,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19965.41,130,MS-DRG,15972.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5630.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5630.26,100,,4504.208,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5911.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12382.71,100,MS-DRG,9906.168,other,100% UHC DRG rate for inpatient setting,12382.71,100,MS-DRG,9906.168,other,100% UHC DRG rate for inpatient setting,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5742.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15358.01,100,MS-DRG,12286.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5630.26,19965.41,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32453.51,130,MS-DRG,25962.808,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9640.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9640.56,100,,7712.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10122.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22676.81,100,MS-DRG,18141.448,other,100% UHC DRG rate for inpatient setting,22676.81,100,MS-DRG,18141.448,other,100% UHC DRG rate for inpatient setting,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9833.37,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24964.24,100,MS-DRG,19971.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9640.56,32453.51,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20409.13,130,MS-DRG,16327.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5070.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5070.34,100,,4056.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5323.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12748.47,100,MS-DRG,10198.776,other,100% UHC DRG rate for inpatient setting,12748.47,100,MS-DRG,10198.776,other,100% UHC DRG rate for inpatient setting,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5171.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15699.33,100,MS-DRG,12559.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5070.34,20409.13,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17871.35,130,MS-DRG,14297.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3613.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3613.34,100,,2890.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3794.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10656.55,100,MS-DRG,8525.24,other,100% UHC DRG rate for inpatient setting,10656.55,100,MS-DRG,8525.24,other,100% UHC DRG rate for inpatient setting,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3685.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13747.19,100,MS-DRG,10997.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3613.34,17871.35,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30533.1,130,MS-DRG,24426.48,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4471.92,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4471.92,100,,3577.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4695.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21093.8,100,MS-DRG,16875.04,other,100% UHC DRG rate for inpatient setting,21093.8,100,MS-DRG,16875.04,other,100% UHC DRG rate for inpatient setting,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4561.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23487,100,MS-DRG,18789.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4471.92,30533.1,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18007.87,130,MS-DRG,14406.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4219.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4219.61,100,,3375.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4430.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10769.09,100,MS-DRG,8615.272,other,100% UHC DRG rate for inpatient setting,10769.09,100,MS-DRG,8615.272,other,100% UHC DRG rate for inpatient setting,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4304.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13852.21,100,MS-DRG,11081.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4219.61,18007.87,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14739.28,130,MS-DRG,11791.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2898.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2898.67,100,,2318.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3043.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8074.75,100,MS-DRG,6459.8,other,100% UHC DRG rate for inpatient setting,8074.75,100,MS-DRG,6459.8,other,100% UHC DRG rate for inpatient setting,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2956.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11337.91,100,MS-DRG,9070.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2898.67,14739.28,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29036.35,130,MS-DRG,23229.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7542.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7542.15,100,,6033.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7919.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19860,100,MS-DRG,15888,other,100% UHC DRG rate for inpatient setting,19860,100,MS-DRG,15888,other,100% UHC DRG rate for inpatient setting,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7693,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22335.65,100,MS-DRG,17868.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7542.15,29036.35,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19555.84,130,MS-DRG,15644.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4786.27,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4786.27,100,,3829.016,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5025.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12045.09,100,MS-DRG,9636.072,other,100% UHC DRG rate for inpatient setting,12045.09,100,MS-DRG,9636.072,other,100% UHC DRG rate for inpatient setting,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4881.99,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15042.95,100,MS-DRG,12034.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4786.27,19555.84,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16076.44,130,MS-DRG,12861.152,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2977.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2977.54,100,,2382.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3126.42,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9176.98,100,MS-DRG,7341.584,other,100% UHC DRG rate for inpatient setting,9176.98,100,MS-DRG,7341.584,other,100% UHC DRG rate for inpatient setting,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3037.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12366.49,100,MS-DRG,9893.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2977.54,16076.44,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34299.62,130,MS-DRG,27439.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8343.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8343.17,100,,6674.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8760.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24198.58,100,MS-DRG,19358.864,other,100% UHC DRG rate for inpatient setting,24198.58,100,MS-DRG,19358.864,other,100% UHC DRG rate for inpatient setting,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8510.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26384.32,100,MS-DRG,21107.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8343.17,34299.62,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22187.97,130,MS-DRG,17750.376,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5976.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5976.76,100,,4781.408,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6275.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14214.8,100,MS-DRG,11371.84,other,100% UHC DRG rate for inpatient setting,14214.8,100,MS-DRG,11371.84,other,100% UHC DRG rate for inpatient setting,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6096.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17067.67,100,MS-DRG,13654.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5976.76,22187.97,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18622.25,130,MS-DRG,14897.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4222.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4222.98,100,,3378.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4434.13,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11275.52,100,MS-DRG,9020.416,other,100% UHC DRG rate for inpatient setting,11275.52,100,MS-DRG,9020.416,other,100% UHC DRG rate for inpatient setting,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4307.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14324.81,100,MS-DRG,11459.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4222.98,18622.25,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,47895.97,130,MS-DRG,38316.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13253.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13253.9,100,,10603.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13916.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35406.24,100,MS-DRG,28324.992,other,100% UHC DRG rate for inpatient setting,35406.24,100,MS-DRG,28324.992,other,100% UHC DRG rate for inpatient setting,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13518.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,36843.05,100,MS-DRG,29474.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13253.9,47895.97,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26996.49,130,MS-DRG,21597.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6126.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6126.64,100,,4901.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6432.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18178.52,100,MS-DRG,14542.816,other,100% UHC DRG rate for inpatient setting,18178.52,100,MS-DRG,14542.816,other,100% UHC DRG rate for inpatient setting,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6249.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20766.53,100,MS-DRG,16613.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6126.64,26996.49,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17804.1,130,MS-DRG,14243.28,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5601.48,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5601.48,100,,4481.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5881.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10601.1,100,MS-DRG,8480.88,other,100% UHC DRG rate for inpatient setting,10601.1,100,MS-DRG,8480.88,other,100% UHC DRG rate for inpatient setting,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5713.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13695.46,100,MS-DRG,10956.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5601.48,17804.1,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21527.43,130,MS-DRG,17221.944,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5298.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5298.35,100,,4238.68,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5563.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13670.3,100,MS-DRG,10936.24,other,100% UHC DRG rate for inpatient setting,13670.3,100,MS-DRG,10936.24,other,100% UHC DRG rate for inpatient setting,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5404.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16559.56,100,MS-DRG,13247.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5298.35,21527.43,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14864.77,130,MS-DRG,11891.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4310.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4310.82,100,,3448.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4526.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8178.18,100,MS-DRG,6542.544,other,100% UHC DRG rate for inpatient setting,8178.18,100,MS-DRG,6542.544,other,100% UHC DRG rate for inpatient setting,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4397.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11434.44,100,MS-DRG,9147.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4310.82,14864.77,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12409.32,130,MS-DRG,9927.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2174.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2174.66,100,,1739.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2283.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6154.12,100,MS-DRG,4923.296,other,100% UHC DRG rate for inpatient setting,6154.12,100,MS-DRG,4923.296,other,100% UHC DRG rate for inpatient setting,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2218.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9545.63,100,MS-DRG,7636.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2174.66,12409.32,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22488.13,130,MS-DRG,17990.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6415.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6415.95,100,,5132.76,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6736.75,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14462.22,100,MS-DRG,11569.776,other,100% UHC DRG rate for inpatient setting,14462.22,100,MS-DRG,11569.776,other,100% UHC DRG rate for inpatient setting,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6544.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17298.56,100,MS-DRG,13838.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6415.95,22488.13,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15406.86,130,MS-DRG,12325.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3762.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3762.11,100,,3009.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3950.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8625.03,100,MS-DRG,6900.024,other,100% UHC DRG rate for inpatient setting,8625.03,100,MS-DRG,6900.024,other,100% UHC DRG rate for inpatient setting,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3837.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11851.43,100,MS-DRG,9481.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3762.11,15406.86,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12136.28,130,MS-DRG,9709.024,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2951.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2951.75,100,,2361.4,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3099.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5929.04,100,MS-DRG,4743.232,other,100% UHC DRG rate for inpatient setting,5929.04,100,MS-DRG,4743.232,other,100% UHC DRG rate for inpatient setting,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3010.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9335.6,100,MS-DRG,7468.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2951.75,12136.28,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26014.7,130,MS-DRG,20811.76,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6282.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6282.14,100,,5025.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6596.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17369.23,100,MS-DRG,13895.384,other,100% UHC DRG rate for inpatient setting,17369.23,100,MS-DRG,13895.384,other,100% UHC DRG rate for inpatient setting,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6407.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20011.31,100,MS-DRG,16009.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6282.14,26014.7,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16972.9,130,MS-DRG,13578.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4837.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4837.47,100,,3869.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5079.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9915.93,100,MS-DRG,7932.744,other,100% UHC DRG rate for inpatient setting,9915.93,100,MS-DRG,7932.744,other,100% UHC DRG rate for inpatient setting,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4934.22,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13056.08,100,MS-DRG,10444.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4837.47,16972.9,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13892.03,130,MS-DRG,11113.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3011.93,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3011.93,100,,2409.544,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3162.52,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7376.34,100,MS-DRG,5901.072,other,100% UHC DRG rate for inpatient setting,7376.34,100,MS-DRG,5901.072,other,100% UHC DRG rate for inpatient setting,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3072.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10686.18,100,MS-DRG,8548.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3011.93,13892.03,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22915.79,130,MS-DRG,18332.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6078.05,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6078.05,100,,4862.44,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6381.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14814.73,100,MS-DRG,11851.784,other,100% UHC DRG rate for inpatient setting,14814.73,100,MS-DRG,11851.784,other,100% UHC DRG rate for inpatient setting,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6199.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17627.53,100,MS-DRG,14102.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6078.05,22915.79,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14819.61,130,MS-DRG,11855.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3686.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3686.98,100,,2949.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3871.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8140.95,100,MS-DRG,6512.76,other,100% UHC DRG rate for inpatient setting,8140.95,100,MS-DRG,6512.76,other,100% UHC DRG rate for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3760.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11399.7,100,MS-DRG,9119.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3686.98,14819.61,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11300.06,130,MS-DRG,9040.048,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2964.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2964.46,100,,2371.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3112.68,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5239.73,100,MS-DRG,4191.784,other,100% UHC DRG rate for inpatient setting,5239.73,100,MS-DRG,4191.784,other,100% UHC DRG rate for inpatient setting,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3023.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8692.35,100,MS-DRG,6953.88,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2964.46,11300.06,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24503.88,130,MS-DRG,19603.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4753.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4753.37,100,,3802.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4991.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16123.84,100,MS-DRG,12899.072,other,100% UHC DRG rate for inpatient setting,16123.84,100,MS-DRG,12899.072,other,100% UHC DRG rate for inpatient setting,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4848.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18849.14,100,MS-DRG,15079.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4753.37,24503.88,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15715.05,130,MS-DRG,12572.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3631.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3631.66,100,,2905.328,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3813.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8879.08,100,MS-DRG,7103.264,other,100% UHC DRG rate for inpatient setting,8879.08,100,MS-DRG,7103.264,other,100% UHC DRG rate for inpatient setting,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3704.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12088.5,100,MS-DRG,9670.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3631.66,15715.05,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12543.84,130,MS-DRG,10035.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2722.99,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2722.99,100,,2178.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2859.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6265,100,MS-DRG,5012,other,100% UHC DRG rate for inpatient setting,6265,100,MS-DRG,5012,other,100% UHC DRG rate for inpatient setting,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2777.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9649.11,100,MS-DRG,7719.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2722.99,12543.84,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18979.62,130,MS-DRG,15183.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4161.68,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4161.68,100,,3329.344,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4369.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11570.11,100,MS-DRG,9256.088,other,100% UHC DRG rate for inpatient setting,11570.11,100,MS-DRG,9256.088,other,100% UHC DRG rate for inpatient setting,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4244.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14599.71,100,MS-DRG,11679.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4161.68,18979.62,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13734.42,130,MS-DRG,10987.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2985.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2985.39,100,,2388.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3134.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7246.42,100,MS-DRG,5797.136,other,100% UHC DRG rate for inpatient setting,7246.42,100,MS-DRG,5797.136,other,100% UHC DRG rate for inpatient setting,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3045.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10564.94,100,MS-DRG,8451.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2985.39,13734.42,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20673.15,130,MS-DRG,16538.52,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4194.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4194.94,100,,3355.952,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4404.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12966.1,100,MS-DRG,10372.88,other,100% UHC DRG rate for inpatient setting,12966.1,100,MS-DRG,10372.88,other,100% UHC DRG rate for inpatient setting,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4278.84,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15902.42,100,MS-DRG,12721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4194.94,20673.15,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14697.14,130,MS-DRG,11757.712,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3925.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3925.45,100,,3140.36,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4121.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8039.99,100,MS-DRG,6431.992,other,100% UHC DRG rate for inpatient setting,8039.99,100,MS-DRG,6431.992,other,100% UHC DRG rate for inpatient setting,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4003.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11305.49,100,MS-DRG,9044.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3925.45,14697.14,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11811.02,130,MS-DRG,9448.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3166.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3166.67,100,,2533.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3325.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5660.93,100,MS-DRG,4528.744,other,100% UHC DRG rate for inpatient setting,5660.93,100,MS-DRG,4528.744,other,100% UHC DRG rate for inpatient setting,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3230.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9085.4,100,MS-DRG,7268.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3166.67,11811.02,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19534.75,130,MS-DRG,15627.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4610.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4610.96,100,,3688.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4841.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12027.71,100,MS-DRG,9622.168,other,100% UHC DRG rate for inpatient setting,12027.71,100,MS-DRG,9622.168,other,100% UHC DRG rate for inpatient setting,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4703.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15026.73,100,MS-DRG,12021.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4610.96,19534.75,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12938.37,130,MS-DRG,10350.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3138.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3138.64,100,,2510.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3295.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6590.21,100,MS-DRG,5272.168,other,100% UHC DRG rate for inpatient setting,6590.21,100,MS-DRG,5272.168,other,100% UHC DRG rate for inpatient setting,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3201.41,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9952.59,100,MS-DRG,7962.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3138.64,12938.37,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10555.18,130,MS-DRG,8444.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2198.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2198.95,100,,1759.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2308.9,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4625.73,100,MS-DRG,3700.584,other,100% UHC DRG rate for inpatient setting,4625.73,100,MS-DRG,3700.584,other,100% UHC DRG rate for inpatient setting,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2242.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8119.37,100,MS-DRG,6495.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2198.95,10555.18,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17749.89,130,MS-DRG,14199.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4127.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4127.29,100,,3301.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4333.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10556.42,100,MS-DRG,8445.136,other,100% UHC DRG rate for inpatient setting,10556.42,100,MS-DRG,8445.136,other,100% UHC DRG rate for inpatient setting,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4209.84,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13653.76,100,MS-DRG,10923.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4127.29,17749.89,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12829.93,130,MS-DRG,10263.944,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2783.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2783.55,100,,2226.84,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2922.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6500.84,100,MS-DRG,5200.672,other,100% UHC DRG rate for inpatient setting,6500.84,100,MS-DRG,5200.672,other,100% UHC DRG rate for inpatient setting,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2839.22,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9869.18,100,MS-DRG,7895.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2783.55,12829.93,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21202.17,130,MS-DRG,16961.736,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4688.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4688.71,100,,3750.968,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4923.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13402.19,100,MS-DRG,10721.752,other,100% UHC DRG rate for inpatient setting,13402.19,100,MS-DRG,10721.752,other,100% UHC DRG rate for inpatient setting,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4782.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16309.36,100,MS-DRG,13047.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4688.71,21202.17,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14348.79,130,MS-DRG,11479.032,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3710.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3710.15,100,,2968.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3895.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7752.85,100,MS-DRG,6202.28,other,100% UHC DRG rate for inpatient setting,7752.85,100,MS-DRG,6202.28,other,100% UHC DRG rate for inpatient setting,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3784.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11037.53,100,MS-DRG,8830.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3710.15,14348.79,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11443.6,130,MS-DRG,9154.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2510.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2510.69,100,,2008.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2636.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5358.06,100,MS-DRG,4286.448,other,100% UHC DRG rate for inpatient setting,5358.06,100,MS-DRG,4286.448,other,100% UHC DRG rate for inpatient setting,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2560.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8802.77,100,MS-DRG,7042.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2510.69,11443.6,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27496.42,130,MS-DRG,21997.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18590.62,100,MS-DRG,14872.496,other,100% UHC DRG rate for inpatient setting,18590.62,100,MS-DRG,14872.496,other,100% UHC DRG rate for inpatient setting,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,21151.09,100,MS-DRG,16920.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18590.62,27496.42,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20135.08,130,MS-DRG,16108.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12522.56,100,MS-DRG,10018.048,other,100% UHC DRG rate for inpatient setting,12522.56,100,MS-DRG,10018.048,other,100% UHC DRG rate for inpatient setting,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,15488.52,100,MS-DRG,12390.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12522.56,20135.08,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16117.6,130,MS-DRG,12894.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9210.9,100,MS-DRG,7368.72,other,100% UHC DRG rate for inpatient setting,9210.9,100,MS-DRG,7368.72,other,100% UHC DRG rate for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9210.9,16117.6,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,60208.37,130,MS-DRG,48166.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14572.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14572.6,100,,11658.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15301.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,45555.53,100,MS-DRG,36444.424,other,100% UHC DRG rate for inpatient setting,45555.53,100,MS-DRG,36444.424,other,100% UHC DRG rate for inpatient setting,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14864.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,46314.13,100,MS-DRG,37051.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14572.6,60208.37,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33929.18,130,MS-DRG,27143.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10463.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10463.63,100,,8370.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10986.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23893.24,100,MS-DRG,19114.592,other,100% UHC DRG rate for inpatient setting,23893.24,100,MS-DRG,19114.592,other,100% UHC DRG rate for inpatient setting,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10672.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26099.37,100,MS-DRG,20879.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10463.63,33929.18,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26536.73,130,MS-DRG,21229.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7698.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7698.02,100,,6158.416,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8082.92,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17799.53,100,MS-DRG,14239.624,other,100% UHC DRG rate for inpatient setting,17799.53,100,MS-DRG,14239.624,other,100% UHC DRG rate for inpatient setting,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7851.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20412.87,100,MS-DRG,16330.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7698.02,26536.73,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42309.46,130,MS-DRG,33847.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11536,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11536,100,,9228.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12112.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30801.21,100,MS-DRG,24640.968,other,100% UHC DRG rate for inpatient setting,30801.21,100,MS-DRG,24640.968,other,100% UHC DRG rate for inpatient setting,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11766.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32545.74,100,MS-DRG,26036.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11536,42309.46,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24592.24,130,MS-DRG,19673.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7442.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7442.35,100,,5953.88,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7814.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16196.66,100,MS-DRG,12957.328,other,100% UHC DRG rate for inpatient setting,16196.66,100,MS-DRG,12957.328,other,100% UHC DRG rate for inpatient setting,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7591.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18917.11,100,MS-DRG,15133.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7442.35,24592.24,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20656.08,130,MS-DRG,16524.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5246.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5246.02,100,,4196.816,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5508.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12952.03,100,MS-DRG,10361.624,other,100% UHC DRG rate for inpatient setting,12952.03,100,MS-DRG,10361.624,other,100% UHC DRG rate for inpatient setting,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5350.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15889.29,100,MS-DRG,12711.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5246.02,20656.08,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35465.11,130,MS-DRG,28372.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13878.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13878.49,100,,11102.792,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14572.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23836.14,100,MS-DRG,19068.912,other,100% UHC DRG rate for inpatient setting,23836.14,100,MS-DRG,19068.912,other,100% UHC DRG rate for inpatient setting,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14156.06,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27280.85,100,MS-DRG,21824.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13878.49,35465.11,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25684.43,130,MS-DRG,20547.544,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7088.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7088.38,100,,5670.704,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7442.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16926.51,100,MS-DRG,13541.208,other,100% UHC DRG rate for inpatient setting,16926.51,100,MS-DRG,13541.208,other,100% UHC DRG rate for inpatient setting,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7230.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19757.25,100,MS-DRG,15805.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7088.38,25684.43,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20097.92,130,MS-DRG,16078.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5232.93,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5232.93,100,,4186.344,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5494.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12491.94,100,MS-DRG,9993.552,other,100% UHC DRG rate for inpatient setting,12491.94,100,MS-DRG,9993.552,other,100% UHC DRG rate for inpatient setting,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5337.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15459.94,100,MS-DRG,12367.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5232.93,20097.92,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,40331.84,130,MS-DRG,32265.472,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13626.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13626.56,100,,10901.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14307.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29171.03,100,MS-DRG,23336.824,other,100% UHC DRG rate for inpatient setting,29171.03,100,MS-DRG,23336.824,other,100% UHC DRG rate for inpatient setting,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13899.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31024.49,100,MS-DRG,24819.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13626.56,40331.84,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24777.95,130,MS-DRG,19822.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6591.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6591.25,100,,5273,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6920.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16349.75,100,MS-DRG,13079.8,other,100% UHC DRG rate for inpatient setting,16349.75,100,MS-DRG,13079.8,other,100% UHC DRG rate for inpatient setting,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6723.08,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19059.96,100,MS-DRG,15247.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6591.25,24777.95,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18387.34,130,MS-DRG,14709.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3508.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3508.31,100,,2806.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3683.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11081.88,100,MS-DRG,8865.504,other,100% UHC DRG rate for inpatient setting,11081.88,100,MS-DRG,8865.504,other,100% UHC DRG rate for inpatient setting,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3578.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14144.11,100,MS-DRG,11315.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3508.31,18387.34,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28211.17,130,MS-DRG,22568.936,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8334.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8334.94,100,,6667.952,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8751.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19179.8,100,MS-DRG,15343.84,other,100% UHC DRG rate for inpatient setting,19179.8,100,MS-DRG,15343.84,other,100% UHC DRG rate for inpatient setting,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8501.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21700.9,100,MS-DRG,17360.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8334.94,28211.17,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21353.76,130,MS-DRG,17083.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5654.19,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5654.19,100,,4523.352,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5936.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13527.14,100,MS-DRG,10821.712,other,100% UHC DRG rate for inpatient setting,13527.14,100,MS-DRG,10821.712,other,100% UHC DRG rate for inpatient setting,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5767.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16425.97,100,MS-DRG,13140.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5654.19,21353.76,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18126.33,130,MS-DRG,14501.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4442.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4442.39,100,,3553.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4664.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10866.73,100,MS-DRG,8693.384,other,100% UHC DRG rate for inpatient setting,10866.73,100,MS-DRG,8693.384,other,100% UHC DRG rate for inpatient setting,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4531.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13943.33,100,MS-DRG,11154.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4442.39,18126.33,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37075.31,130,MS-DRG,29660.248,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12763.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12763.13,100,,10210.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13401.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26486.62,100,MS-DRG,21189.296,other,100% UHC DRG rate for inpatient setting,26486.62,100,MS-DRG,21189.296,other,100% UHC DRG rate for inpatient setting,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13018.39,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28519.47,100,MS-DRG,22815.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12763.13,37075.31,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22105.66,130,MS-DRG,17684.528,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5090.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5090.15,100,,4072.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5344.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14146.94,100,MS-DRG,11317.552,other,100% UHC DRG rate for inpatient setting,14146.94,100,MS-DRG,11317.552,other,100% UHC DRG rate for inpatient setting,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5191.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17004.35,100,MS-DRG,13603.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5090.15,22105.66,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19108.12,130,MS-DRG,15286.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4513.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4513.41,100,,3610.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4739.08,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11676.03,100,MS-DRG,9340.824,other,100% UHC DRG rate for inpatient setting,11676.03,100,MS-DRG,9340.824,other,100% UHC DRG rate for inpatient setting,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4603.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14698.55,100,MS-DRG,11758.84,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4513.41,19108.12,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,44203.74,130,MS-DRG,35362.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12043.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12043.6,100,,9634.88,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12645.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32362.7,100,MS-DRG,25890.16,other,100% UHC DRG rate for inpatient setting,32362.7,100,MS-DRG,25890.16,other,100% UHC DRG rate for inpatient setting,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12284.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,34002.88,100,MS-DRG,27202.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12043.6,44203.74,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26342.98,130,MS-DRG,21074.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6858.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6858.13,100,,5486.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7201.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17272.41,100,MS-DRG,13817.928,other,100% UHC DRG rate for inpatient setting,17272.41,100,MS-DRG,13817.928,other,100% UHC DRG rate for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6995.3,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6858.13,26342.98,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21024.5,130,MS-DRG,16819.6,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6740.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6740.39,100,,5392.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7077.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13255.72,100,MS-DRG,10604.576,other,100% UHC DRG rate for inpatient setting,13255.72,100,MS-DRG,10604.576,other,100% UHC DRG rate for inpatient setting,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6875.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16172.69,100,MS-DRG,12938.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6740.39,21024.5,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24177.63,130,MS-DRG,19342.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7003.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7003.53,100,,5602.824,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7353.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15854.9,100,MS-DRG,12683.92,other,100% UHC DRG rate for inpatient setting,15854.9,100,MS-DRG,12683.92,other,100% UHC DRG rate for inpatient setting,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7143.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18598.18,100,MS-DRG,14878.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7003.53,24177.63,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15293.43,130,MS-DRG,12234.744,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3524.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3524.38,100,,2819.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3700.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8531.53,100,MS-DRG,6825.224,other,100% UHC DRG rate for inpatient setting,8531.53,100,MS-DRG,6825.224,other,100% UHC DRG rate for inpatient setting,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3594.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11764.18,100,MS-DRG,9411.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3524.38,15293.43,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11664.45,130,MS-DRG,9331.56,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2452,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2452,100,,1961.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2574.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5540.11,100,MS-DRG,4432.088,other,100% UHC DRG rate for inpatient setting,5540.11,100,MS-DRG,4432.088,other,100% UHC DRG rate for inpatient setting,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2501.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8972.65,100,MS-DRG,7178.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2452,11664.45,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22610.6,130,MS-DRG,18088.48,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5347.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5347.31,100,,4277.848,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5614.68,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14563.17,100,MS-DRG,11650.536,other,100% UHC DRG rate for inpatient setting,14563.17,100,MS-DRG,11650.536,other,100% UHC DRG rate for inpatient setting,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5454.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17392.77,100,MS-DRG,13914.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5347.31,22610.6,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15993.12,130,MS-DRG,12794.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3937.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3937.04,100,,3149.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4133.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9108.29,100,MS-DRG,7286.632,other,100% UHC DRG rate for inpatient setting,9108.29,100,MS-DRG,7286.632,other,100% UHC DRG rate for inpatient setting,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4015.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12302.4,100,MS-DRG,9841.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3937.04,15993.12,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13286.7,130,MS-DRG,10629.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3092.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3092.29,100,,2473.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3246.9,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6877.35,100,MS-DRG,5501.88,other,100% UHC DRG rate for inpatient setting,6877.35,100,MS-DRG,5501.88,other,100% UHC DRG rate for inpatient setting,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3154.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10220.54,100,MS-DRG,8176.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3092.29,13286.7,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21696.08,130,MS-DRG,17356.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6614.43,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6614.43,100,,5291.544,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6945.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13809.32,100,MS-DRG,11047.456,other,100% UHC DRG rate for inpatient setting,13809.32,100,MS-DRG,11047.456,other,100% UHC DRG rate for inpatient setting,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6746.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16689.29,100,MS-DRG,13351.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6614.43,21696.08,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13528.63,130,MS-DRG,10822.904,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3358.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3358.8,100,,2687.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3526.74,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7076.78,100,MS-DRG,5661.424,other,100% UHC DRG rate for inpatient setting,7076.78,100,MS-DRG,5661.424,other,100% UHC DRG rate for inpatient setting,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3425.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10406.64,100,MS-DRG,8325.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3358.8,13528.63,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11123.36,130,MS-DRG,8898.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2459.48,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2459.48,100,,1967.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2582.45,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5094.09,100,MS-DRG,4075.272,other,100% UHC DRG rate for inpatient setting,5094.09,100,MS-DRG,4075.272,other,100% UHC DRG rate for inpatient setting,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2508.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8556.43,100,MS-DRG,6845.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2459.48,11123.36,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23296.23,130,MS-DRG,18636.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6794.59,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6794.59,100,,5435.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7134.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15128.36,100,MS-DRG,12102.688,other,100% UHC DRG rate for inpatient setting,15128.36,100,MS-DRG,12102.688,other,100% UHC DRG rate for inpatient setting,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6930.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17920.18,100,MS-DRG,14336.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6794.59,23296.23,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14495.34,130,MS-DRG,11596.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4093.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4093.65,100,,3274.92,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4298.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7873.66,100,MS-DRG,6298.928,other,100% UHC DRG rate for inpatient setting,7873.66,100,MS-DRG,6298.928,other,100% UHC DRG rate for inpatient setting,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4175.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11150.26,100,MS-DRG,8920.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4093.65,14495.34,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12118.21,130,MS-DRG,9694.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2546.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2546.57,100,,2037.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2673.9,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5914.14,100,MS-DRG,4731.312,other,100% UHC DRG rate for inpatient setting,5914.14,100,MS-DRG,4731.312,other,100% UHC DRG rate for inpatient setting,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2597.5,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9321.7,100,MS-DRG,7457.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2546.57,12118.21,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21338.71,130,MS-DRG,17070.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5711.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5711.75,100,,4569.4,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5997.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13514.73,100,MS-DRG,10811.784,other,100% UHC DRG rate for inpatient setting,13514.73,100,MS-DRG,10811.784,other,100% UHC DRG rate for inpatient setting,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5825.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16414.39,100,MS-DRG,13131.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5711.75,21338.71,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15853.59,130,MS-DRG,12682.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4149.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4149.34,100,,3319.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4356.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8993.27,100,MS-DRG,7194.616,other,100% UHC DRG rate for inpatient setting,8993.27,100,MS-DRG,7194.616,other,100% UHC DRG rate for inpatient setting,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4232.33,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12195.07,100,MS-DRG,9756.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4149.34,15853.59,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12989.56,130,MS-DRG,10391.648,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2633.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2633.29,100,,2106.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2764.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6632.41,100,MS-DRG,5305.928,other,100% UHC DRG rate for inpatient setting,6632.41,100,MS-DRG,5305.928,other,100% UHC DRG rate for inpatient setting,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2685.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9991.97,100,MS-DRG,7993.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2633.29,12989.56,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,453,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,93900.11,130,MS-DRG,75120.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34126.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,34126.58,100,,27301.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35832.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,73328.09,100,MS-DRG,58662.472,other,100% UHC DRG rate for inpatient setting,73328.09,100,MS-DRG,58662.472,other,100% UHC DRG rate for inpatient setting,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34809.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,72230.85,100,MS-DRG,57784.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34126.58,93900.11,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,454,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,66342.99,130,MS-DRG,53074.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19934.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,19934.11,100,,15947.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20930.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50612.38,100,MS-DRG,40489.904,other,100% UHC DRG rate for inpatient setting,50612.38,100,MS-DRG,40489.904,other,100% UHC DRG rate for inpatient setting,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20332.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51033.07,100,MS-DRG,40826.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19934.11,66342.99,
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,455,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,51177.61,130,MS-DRG,40942.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18347.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18347.79,100,,14678.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19265.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38111.34,100,MS-DRG,30489.072,other,100% UHC DRG rate for inpatient setting,38111.34,100,MS-DRG,30489.072,other,100% UHC DRG rate for inpatient setting,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18714.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,39367.39,100,MS-DRG,31493.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18347.79,51177.61,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,89563.42,130,MS-DRG,71650.736,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41889.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,41889.64,100,,33511.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43984.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,69753.29,100,MS-DRG,55802.632,other,100% UHC DRG rate for inpatient setting,69753.29,100,MS-DRG,55802.632,other,100% UHC DRG rate for inpatient setting,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42727.43,102,,,other,102% GA Medicaid DRG rate for inpatient setting,68894.94,100,MS-DRG,55115.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41889.64,89563.42,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,65931.41,130,MS-DRG,52745.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29387.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,29387.78,100,,23510.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30857.17,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50273.11,100,MS-DRG,40218.488,other,100% UHC DRG rate for inpatient setting,50273.11,100,MS-DRG,40218.488,other,100% UHC DRG rate for inpatient setting,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29975.54,102,,,other,102% GA Medicaid DRG rate for inpatient setting,50716.47,100,MS-DRG,40573.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29387.78,65931.41,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,50428.72,130,MS-DRG,40342.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28200.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,28200.66,100,,22560.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29610.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37494.03,100,MS-DRG,29995.224,other,100% UHC DRG rate for inpatient setting,37494.03,100,MS-DRG,29995.224,other,100% UHC DRG rate for inpatient setting,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28764.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38791.32,100,MS-DRG,31033.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28200.66,50428.72,
SPINAL FUSION EXCEPT CERVICAL WITH MCC,459,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,71522.95,130,MS-DRG,57218.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33635.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,33635.06,100,,26908.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35316.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,54882.28,100,MS-DRG,43905.824,other,100% UHC DRG rate for inpatient setting,54882.28,100,MS-DRG,43905.824,other,100% UHC DRG rate for inpatient setting,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34307.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,55017.65,100,MS-DRG,44014.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33635.06,71522.95,
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,460,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41663.99,130,MS-DRG,33331.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15021.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15021.14,100,,12016.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15772.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30269.12,100,MS-DRG,24215.296,other,100% UHC DRG rate for inpatient setting,30269.12,100,MS-DRG,24215.296,other,100% UHC DRG rate for inpatient setting,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15321.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32049.22,100,MS-DRG,25639.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15021.14,41663.99,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,73392.15,130,MS-DRG,58713.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14931.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14931.8,100,,11945.44,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15678.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56423.09,100,MS-DRG,45138.472,other,100% UHC DRG rate for inpatient setting,56423.09,100,MS-DRG,45138.472,other,100% UHC DRG rate for inpatient setting,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15230.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,56455.5,100,MS-DRG,45164.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14931.8,73392.15,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33516.6,130,MS-DRG,26813.28,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14931.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14931.8,100,,11945.44,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15678.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23553.13,100,MS-DRG,18842.504,other,100% UHC DRG rate for inpatient setting,23553.13,100,MS-DRG,18842.504,other,100% UHC DRG rate for inpatient setting,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15230.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25782,100,MS-DRG,20625.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14931.8,33516.6,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,61799.5,130,MS-DRG,49439.6,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21592.21,100,,,other,100% GA Medicaid DRG rate for inpatient setting,21592.21,100,,17273.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22671.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,46867.12,100,MS-DRG,37493.696,other,100% UHC DRG rate for inpatient setting,46867.12,100,MS-DRG,37493.696,other,100% UHC DRG rate for inpatient setting,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22024.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,47538.08,100,MS-DRG,38030.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21592.21,61799.5,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35073.6,130,MS-DRG,28058.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11254.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11254.55,100,,9003.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11817.27,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24836.59,100,MS-DRG,19869.272,other,100% UHC DRG rate for inpatient setting,24836.59,100,MS-DRG,19869.272,other,100% UHC DRG rate for inpatient setting,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11479.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26979.69,100,MS-DRG,21583.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11254.55,35073.6,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23723.9,130,MS-DRG,18979.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5484.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5484.86,100,,4387.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5759.11,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15480.87,100,MS-DRG,12384.696,other,100% UHC DRG rate for inpatient setting,15480.87,100,MS-DRG,12384.696,other,100% UHC DRG rate for inpatient setting,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5594.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18249.15,100,MS-DRG,14599.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5484.86,23723.9,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,57010.06,130,MS-DRG,45608.048,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12138.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12138.16,100,,9710.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12745.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42919.12,100,MS-DRG,34335.296,other,100% UHC DRG rate for inpatient setting,42919.12,100,MS-DRG,34335.296,other,100% UHC DRG rate for inpatient setting,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12380.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,43853.89,100,MS-DRG,35083.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12138.16,57010.06,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39941.36,130,MS-DRG,31953.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11003.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11003.74,100,,8802.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11553.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28849.13,100,MS-DRG,23079.304,other,100% UHC DRG rate for inpatient setting,28849.13,100,MS-DRG,23079.304,other,100% UHC DRG rate for inpatient setting,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11223.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30724.12,100,MS-DRG,24579.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11003.74,39941.36,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31742.76,130,MS-DRG,25394.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8832.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8832.82,100,,7066.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9274.46,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22090.94,100,MS-DRG,17672.752,other,100% UHC DRG rate for inpatient setting,22090.94,100,MS-DRG,17672.752,other,100% UHC DRG rate for inpatient setting,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9009.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24417.51,100,MS-DRG,19534.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8832.82,31742.76,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38370.28,130,MS-DRG,30696.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10764.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10764.89,100,,8611.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11303.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27554.1,100,MS-DRG,22043.28,other,100% UHC DRG rate for inpatient setting,27554.1,100,MS-DRG,22043.28,other,100% UHC DRG rate for inpatient setting,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10980.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29515.6,100,MS-DRG,23612.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10764.89,38370.28,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23833.32,130,MS-DRG,19066.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8103.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8103.95,100,,6483.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8509.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15571.07,100,MS-DRG,12456.856,other,100% UHC DRG rate for inpatient setting,15571.07,100,MS-DRG,12456.856,other,100% UHC DRG rate for inpatient setting,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8266.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18333.32,100,MS-DRG,14666.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8103.95,23833.32,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,54323.72,130,MS-DRG,43458.976,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12637.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12637.54,100,,10110.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13269.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40704.73,100,MS-DRG,32563.784,other,100% UHC DRG rate for inpatient setting,40704.73,100,MS-DRG,32563.784,other,100% UHC DRG rate for inpatient setting,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12890.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,41787.48,100,MS-DRG,33429.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12637.54,54323.72,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34611.82,130,MS-DRG,27689.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9762.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9762.41,100,,7809.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10250.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24455.94,100,MS-DRG,19564.752,other,100% UHC DRG rate for inpatient setting,24455.94,100,MS-DRG,19564.752,other,100% UHC DRG rate for inpatient setting,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9957.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26624.48,100,MS-DRG,21299.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9762.41,34611.82,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29644.69,130,MS-DRG,23715.752,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7570.19,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7570.19,100,,6056.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7948.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20361.47,100,MS-DRG,16289.176,other,100% UHC DRG rate for inpatient setting,20361.47,100,MS-DRG,16289.176,other,100% UHC DRG rate for inpatient setting,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7721.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22803.61,100,MS-DRG,18242.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7570.19,29644.69,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,48137.9,130,MS-DRG,38510.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13063.27,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13063.27,100,,10450.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13716.44,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35605.67,100,MS-DRG,28484.536,other,100% UHC DRG rate for inpatient setting,35605.67,100,MS-DRG,28484.536,other,100% UHC DRG rate for inpatient setting,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13324.54,102,,,other,102% GA Medicaid DRG rate for inpatient setting,37029.15,100,MS-DRG,29623.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13063.27,48137.9,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26473.47,130,MS-DRG,21178.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8271.4,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8271.4,100,,6617.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8684.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17747.39,100,MS-DRG,14197.912,other,100% UHC DRG rate for inpatient setting,17747.39,100,MS-DRG,14197.912,other,100% UHC DRG rate for inpatient setting,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8436.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20364.21,100,MS-DRG,16291.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8271.4,26473.47,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16758.07,130,MS-DRG,13406.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3585.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3585.31,100,,2868.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3764.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9738.85,100,MS-DRG,7791.08,other,100% UHC DRG rate for inpatient setting,9738.85,100,MS-DRG,7791.08,other,100% UHC DRG rate for inpatient setting,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3657.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12890.82,100,MS-DRG,10312.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3585.31,16758.07,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38763.79,130,MS-DRG,31011.032,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10515.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10515.95,100,,8412.76,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11041.75,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27878.48,100,MS-DRG,22302.784,other,100% UHC DRG rate for inpatient setting,27878.48,100,MS-DRG,22302.784,other,100% UHC DRG rate for inpatient setting,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10726.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29818.3,100,MS-DRG,23854.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10515.95,38763.79,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28872.73,130,MS-DRG,23098.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8414.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8414.18,100,,6731.344,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8834.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19725.12,100,MS-DRG,15780.096,other,100% UHC DRG rate for inpatient setting,19725.12,100,MS-DRG,15780.096,other,100% UHC DRG rate for inpatient setting,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8582.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22209.79,100,MS-DRG,17767.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8414.18,28872.73,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23655.63,130,MS-DRG,18924.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6323.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6323.63,100,,5058.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6639.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15424.6,100,MS-DRG,12339.68,other,100% UHC DRG rate for inpatient setting,15424.6,100,MS-DRG,12339.68,other,100% UHC DRG rate for inpatient setting,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6450.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18196.64,100,MS-DRG,14557.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6323.63,23655.63,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34546.56,130,MS-DRG,27637.248,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14381.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14381.97,100,,11505.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15101.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24402.15,100,MS-DRG,19521.72,other,100% UHC DRG rate for inpatient setting,24402.15,100,MS-DRG,19521.72,other,100% UHC DRG rate for inpatient setting,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14669.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26574.28,100,MS-DRG,21259.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14381.97,34546.56,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25772.77,130,MS-DRG,20618.216,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8745.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8745.73,100,,6996.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9183.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17169.8,100,MS-DRG,13735.84,other,100% UHC DRG rate for inpatient setting,17169.8,100,MS-DRG,13735.84,other,100% UHC DRG rate for inpatient setting,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8920.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19825.21,100,MS-DRG,15860.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8745.73,25772.77,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20888.99,130,MS-DRG,16711.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6198.41,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6198.41,100,,4958.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6508.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13144.01,100,MS-DRG,10515.208,other,100% UHC DRG rate for inpatient setting,13144.01,100,MS-DRG,10515.208,other,100% UHC DRG rate for inpatient setting,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6322.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16068.45,100,MS-DRG,12854.76,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6198.41,20888.99,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29881.61,130,MS-DRG,23905.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8631.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8631.72,100,,6905.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9063.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20556.76,100,MS-DRG,16445.408,other,100% UHC DRG rate for inpatient setting,20556.76,100,MS-DRG,16445.408,other,100% UHC DRG rate for inpatient setting,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8804.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22985.85,100,MS-DRG,18388.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8631.72,29881.61,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38010.91,130,MS-DRG,30408.728,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7603.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7603.83,100,,6083.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7984.02,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27257.85,100,MS-DRG,21806.28,other,100% UHC DRG rate for inpatient setting,27257.85,100,MS-DRG,21806.28,other,100% UHC DRG rate for inpatient setting,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7755.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29239.16,100,MS-DRG,23391.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7603.83,38010.91,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25104.21,130,MS-DRG,20083.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7053.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7053.25,100,,5642.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7405.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16618.68,100,MS-DRG,13294.944,other,100% UHC DRG rate for inpatient setting,16618.68,100,MS-DRG,13294.944,other,100% UHC DRG rate for inpatient setting,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7194.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19310.93,100,MS-DRG,15448.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7053.25,25104.21,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20452.3,130,MS-DRG,16361.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3869.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3869.38,100,,3095.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4062.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12784.05,100,MS-DRG,10227.24,other,100% UHC DRG rate for inpatient setting,12784.05,100,MS-DRG,10227.24,other,100% UHC DRG rate for inpatient setting,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3946.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15732.54,100,MS-DRG,12586.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3869.38,20452.3,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26091,130,MS-DRG,20872.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5648.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5648.95,100,,4519.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5931.4,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17432.12,100,MS-DRG,13945.696,other,100% UHC DRG rate for inpatient setting,17432.12,100,MS-DRG,13945.696,other,100% UHC DRG rate for inpatient setting,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5761.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20070,100,MS-DRG,16056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5648.95,26091,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17368.43,130,MS-DRG,13894.744,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5045.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5045.67,100,,4036.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5297.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10241.97,100,MS-DRG,8193.576,other,100% UHC DRG rate for inpatient setting,10241.97,100,MS-DRG,8193.576,other,100% UHC DRG rate for inpatient setting,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5146.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13360.33,100,MS-DRG,10688.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5045.67,17368.43,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39698.4,130,MS-DRG,31758.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11875.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11875.77,100,,9500.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12469.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28648.88,100,MS-DRG,22919.104,other,100% UHC DRG rate for inpatient setting,28648.88,100,MS-DRG,22919.104,other,100% UHC DRG rate for inpatient setting,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12113.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30537.23,100,MS-DRG,24429.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11875.77,39698.4,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29053.41,130,MS-DRG,23242.728,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8000.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8000.78,100,,6400.624,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8400.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19874.07,100,MS-DRG,15899.256,other,100% UHC DRG rate for inpatient setting,19874.07,100,MS-DRG,15899.256,other,100% UHC DRG rate for inpatient setting,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8160.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22348.78,100,MS-DRG,17879.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8000.78,29053.41,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23707.84,130,MS-DRG,18966.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5856.4,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5856.4,100,,4685.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6149.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15467.63,100,MS-DRG,12374.104,other,100% UHC DRG rate for inpatient setting,15467.63,100,MS-DRG,12374.104,other,100% UHC DRG rate for inpatient setting,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5973.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18236.8,100,MS-DRG,14589.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5856.4,23707.84,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,40894.01,130,MS-DRG,32715.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9587.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9587.86,100,,7670.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10067.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29634.43,100,MS-DRG,23707.544,other,100% UHC DRG rate for inpatient setting,29634.43,100,MS-DRG,23707.544,other,100% UHC DRG rate for inpatient setting,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9779.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31456.93,100,MS-DRG,25165.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9587.86,40894.01,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24895.4,130,MS-DRG,19916.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5376.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5376.47,100,,4301.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5645.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16446.56,100,MS-DRG,13157.248,other,100% UHC DRG rate for inpatient setting,16446.56,100,MS-DRG,13157.248,other,100% UHC DRG rate for inpatient setting,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5484,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19150.31,100,MS-DRG,15320.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5376.47,24895.4,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19272.75,130,MS-DRG,15418.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4280.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4280.54,100,,3424.432,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4494.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11811.74,100,MS-DRG,9449.392,other,100% UHC DRG rate for inpatient setting,11811.74,100,MS-DRG,9449.392,other,100% UHC DRG rate for inpatient setting,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4366.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14825.19,100,MS-DRG,11860.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4280.54,19272.75,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31154.5,130,MS-DRG,24923.6,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6952.7,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6952.7,100,,5562.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7300.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21606.03,100,MS-DRG,17284.824,other,100% UHC DRG rate for inpatient setting,21606.03,100,MS-DRG,17284.824,other,100% UHC DRG rate for inpatient setting,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7091.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23965,100,MS-DRG,19172,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6952.7,31154.5,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17891.42,130,MS-DRG,14313.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3730.71,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3730.71,100,,2984.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3917.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10673.1,100,MS-DRG,8538.48,other,100% UHC DRG rate for inpatient setting,10673.1,100,MS-DRG,8538.48,other,100% UHC DRG rate for inpatient setting,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3805.32,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13762.63,100,MS-DRG,11010.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3730.71,17891.42,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37496.91,130,MS-DRG,29997.528,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8670.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8670.6,100,,6936.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9104.13,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26834.17,100,MS-DRG,21467.336,other,100% UHC DRG rate for inpatient setting,26834.17,100,MS-DRG,21467.336,other,100% UHC DRG rate for inpatient setting,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8844.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28843.78,100,MS-DRG,23075.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8670.6,37496.91,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22367.67,130,MS-DRG,17894.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6634.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6634.24,100,,5307.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6965.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14362.92,100,MS-DRG,11490.336,other,100% UHC DRG rate for inpatient setting,14362.92,100,MS-DRG,11490.336,other,100% UHC DRG rate for inpatient setting,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6766.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17205.9,100,MS-DRG,13764.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6634.24,22367.67,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18824.01,130,MS-DRG,15059.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4931.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4931.67,100,,3945.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5178.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11441.84,100,MS-DRG,9153.472,other,100% UHC DRG rate for inpatient setting,11441.84,100,MS-DRG,9153.472,other,100% UHC DRG rate for inpatient setting,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5030.3,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14480.01,100,MS-DRG,11584.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4931.67,18824.01,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31866.25,130,MS-DRG,25493,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6435.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6435.01,100,,5148.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6756.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22192.72,100,MS-DRG,17754.176,other,100% UHC DRG rate for inpatient setting,22192.72,100,MS-DRG,17754.176,other,100% UHC DRG rate for inpatient setting,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6563.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24512.5,100,MS-DRG,19610,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6435.01,31866.25,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22281.34,130,MS-DRG,17825.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5606.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5606.72,100,,4485.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5887.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14291.75,100,MS-DRG,11433.4,other,100% UHC DRG rate for inpatient setting,14291.75,100,MS-DRG,11433.4,other,100% UHC DRG rate for inpatient setting,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5718.85,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17139.49,100,MS-DRG,13711.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5606.72,22281.34,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22066.51,130,MS-DRG,17653.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5407.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5407.49,100,,4325.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5677.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14114.67,100,MS-DRG,11291.736,other,100% UHC DRG rate for inpatient setting,14114.67,100,MS-DRG,11291.736,other,100% UHC DRG rate for inpatient setting,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5515.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16974.24,100,MS-DRG,13579.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5407.49,22066.51,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19626.11,130,MS-DRG,15700.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3940.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3940.03,100,,3152.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4137.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12103.02,100,MS-DRG,9682.416,other,100% UHC DRG rate for inpatient setting,12103.02,100,MS-DRG,9682.416,other,100% UHC DRG rate for inpatient setting,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4018.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15097.01,100,MS-DRG,12077.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3940.03,19626.11,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26342.98,130,MS-DRG,21074.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5593.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5593.26,100,,4474.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5872.92,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17639.82,100,MS-DRG,14111.856,other,100% UHC DRG rate for inpatient setting,17639.82,100,MS-DRG,14111.856,other,100% UHC DRG rate for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5705.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20263.83,100,MS-DRG,16211.064,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5593.26,26342.98,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19339,130,MS-DRG,15471.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4714.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4714.5,100,,3771.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4950.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11866.35,100,MS-DRG,9493.08,other,100% UHC DRG rate for inpatient setting,11866.35,100,MS-DRG,9493.08,other,100% UHC DRG rate for inpatient setting,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4808.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14876.15,100,MS-DRG,11900.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4714.5,19339,
ARTHROSCOPY,509,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18657.39,130,MS-DRG,14925.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7704.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7704.75,100,,6163.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8089.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10974.31,100,MS-DRG,8779.448,other,100% UHC DRG rate for inpatient setting,10974.31,100,MS-DRG,8779.448,other,100% UHC DRG rate for inpatient setting,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7858.84,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14351.84,100,MS-DRG,11481.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7704.75,18657.39,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32254.74,130,MS-DRG,25803.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7982.09,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7982.09,100,,6385.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8381.2,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22512.97,100,MS-DRG,18010.376,other,100% UHC DRG rate for inpatient setting,22512.97,100,MS-DRG,18010.376,other,100% UHC DRG rate for inpatient setting,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8141.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24811.34,100,MS-DRG,19849.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7982.09,32254.74,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24958.65,130,MS-DRG,19966.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5862.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5862.38,100,,4689.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6155.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16498.7,100,MS-DRG,13198.96,other,100% UHC DRG rate for inpatient setting,16498.7,100,MS-DRG,13198.96,other,100% UHC DRG rate for inpatient setting,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5979.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19198.96,100,MS-DRG,15359.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5862.38,24958.65,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21143.97,130,MS-DRG,16915.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3862.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3862.28,100,,3089.824,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4055.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13354.2,100,MS-DRG,10683.36,other,100% UHC DRG rate for inpatient setting,13354.2,100,MS-DRG,10683.36,other,100% UHC DRG rate for inpatient setting,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3939.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16264.59,100,MS-DRG,13011.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3862.28,21143.97,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21216.23,130,MS-DRG,16972.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4952.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4952.22,100,,3961.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5199.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13413.78,100,MS-DRG,10731.024,other,100% UHC DRG rate for inpatient setting,13413.78,100,MS-DRG,10731.024,other,100% UHC DRG rate for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5051.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4952.22,21216.23,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15398.84,130,MS-DRG,12319.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4068.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4068.98,100,,3255.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4272.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8618.41,100,MS-DRG,6894.728,other,100% UHC DRG rate for inpatient setting,8618.41,100,MS-DRG,6894.728,other,100% UHC DRG rate for inpatient setting,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4150.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11845.26,100,MS-DRG,9476.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4068.98,15398.84,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,36680.77,130,MS-DRG,29344.616,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13615.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13615.72,100,,10892.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14296.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26161.41,100,MS-DRG,20929.128,other,100% UHC DRG rate for inpatient setting,26161.41,100,MS-DRG,20929.128,other,100% UHC DRG rate for inpatient setting,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13888.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28215.98,100,MS-DRG,22572.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13615.72,36680.77,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25430.47,130,MS-DRG,20344.376,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8133.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8133.47,100,,6506.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8540.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16887.62,100,MS-DRG,13510.096,other,100% UHC DRG rate for inpatient setting,16887.62,100,MS-DRG,13510.096,other,100% UHC DRG rate for inpatient setting,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8296.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19561.9,100,MS-DRG,15649.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8133.47,25430.47,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19945.34,130,MS-DRG,15956.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7505.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7505.52,100,,6004.416,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7880.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12366.16,100,MS-DRG,9892.928,other,100% UHC DRG rate for inpatient setting,12366.16,100,MS-DRG,9892.928,other,100% UHC DRG rate for inpatient setting,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7655.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15342.57,100,MS-DRG,12274.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7505.52,19945.34,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41602.73,130,MS-DRG,33282.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8823.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8823.47,100,,7058.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9264.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30218.65,100,MS-DRG,24174.92,other,100% UHC DRG rate for inpatient setting,30218.65,100,MS-DRG,24174.92,other,100% UHC DRG rate for inpatient setting,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8999.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32002.1,100,MS-DRG,25601.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8823.47,41602.73,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24705.67,130,MS-DRG,19764.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7484.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7484.22,100,,5987.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7858.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16290.17,100,MS-DRG,13032.136,other,100% UHC DRG rate for inpatient setting,16290.17,100,MS-DRG,13032.136,other,100% UHC DRG rate for inpatient setting,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7633.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19004.36,100,MS-DRG,15203.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7484.22,24705.67,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19313.91,130,MS-DRG,15451.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4073.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4073.47,100,,3258.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4277.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11845.66,100,MS-DRG,9476.528,other,100% UHC DRG rate for inpatient setting,11845.66,100,MS-DRG,9476.528,other,100% UHC DRG rate for inpatient setting,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4154.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14856.85,100,MS-DRG,11885.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4073.47,19313.91,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35001.32,130,MS-DRG,28001.056,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24777.01,100,MS-DRG,19821.608,other,100% UHC DRG rate for inpatient setting,24777.01,100,MS-DRG,19821.608,other,100% UHC DRG rate for inpatient setting,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,26924.09,100,MS-DRG,21539.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24777.01,35001.32,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26147.23,130,MS-DRG,20917.784,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17478.46,100,MS-DRG,13982.768,other,100% UHC DRG rate for inpatient setting,17478.46,100,MS-DRG,13982.768,other,100% UHC DRG rate for inpatient setting,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,20113.25,100,MS-DRG,16090.6,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17478.46,26147.23,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21320.64,130,MS-DRG,17056.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3399.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3399.91,100,,2719.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3569.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13499.84,100,MS-DRG,10799.872,other,100% UHC DRG rate for inpatient setting,13499.84,100,MS-DRG,10799.872,other,100% UHC DRG rate for inpatient setting,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3467.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16400.49,100,MS-DRG,13120.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3399.91,21320.64,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13074.89,130,MS-DRG,10459.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1792.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1792.28,100,,1433.824,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1881.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6702.75,100,MS-DRG,5362.2,other,100% UHC DRG rate for inpatient setting,6702.75,100,MS-DRG,5362.2,other,100% UHC DRG rate for inpatient setting,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1828.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10057.61,100,MS-DRG,8046.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1792.28,13074.89,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17960.7,130,MS-DRG,14368.56,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3189.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3189.47,100,,2551.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3348.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10730.19,100,MS-DRG,8584.152,other,100% UHC DRG rate for inpatient setting,10730.19,100,MS-DRG,8584.152,other,100% UHC DRG rate for inpatient setting,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3253.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13815.92,100,MS-DRG,11052.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3189.47,17960.7,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12845,130,MS-DRG,10276,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2721.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2721.5,100,,2177.2,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2857.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6513.25,100,MS-DRG,5210.6,other,100% UHC DRG rate for inpatient setting,6513.25,100,MS-DRG,5210.6,other,100% UHC DRG rate for inpatient setting,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2775.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9880.77,100,MS-DRG,7904.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2721.5,12845,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14650.96,130,MS-DRG,11720.768,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2561.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2561.52,100,,2049.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2689.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8001.93,100,MS-DRG,6401.544,other,100% UHC DRG rate for inpatient setting,8001.93,100,MS-DRG,6401.544,other,100% UHC DRG rate for inpatient setting,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2612.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11269.97,100,MS-DRG,9015.976,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2561.52,14650.96,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12061.97,130,MS-DRG,9649.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1924.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1924.97,100,,1539.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2021.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5867.8,100,MS-DRG,4694.24,other,100% UHC DRG rate for inpatient setting,5867.8,100,MS-DRG,4694.24,other,100% UHC DRG rate for inpatient setting,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1963.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9278.44,100,MS-DRG,7422.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1924.97,12061.97,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24864.28,130,MS-DRG,19891.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6722.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6722.45,100,,5377.96,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7058.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16420.91,100,MS-DRG,13136.728,other,100% UHC DRG rate for inpatient setting,16420.91,100,MS-DRG,13136.728,other,100% UHC DRG rate for inpatient setting,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6856.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19126.37,100,MS-DRG,15301.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6722.45,24864.28,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17975.76,130,MS-DRG,14380.608,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4851.68,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4851.68,100,,3881.344,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5094.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10742.61,100,MS-DRG,8594.088,other,100% UHC DRG rate for inpatient setting,10742.61,100,MS-DRG,8594.088,other,100% UHC DRG rate for inpatient setting,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4948.71,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13827.51,100,MS-DRG,11062.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4851.68,17975.76,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13555.74,130,MS-DRG,10844.592,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2717.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2717.76,100,,2174.208,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2853.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7099.12,100,MS-DRG,5679.296,other,100% UHC DRG rate for inpatient setting,7099.12,100,MS-DRG,5679.296,other,100% UHC DRG rate for inpatient setting,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2772.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10427.49,100,MS-DRG,8341.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2717.76,13555.74,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23251.07,130,MS-DRG,18600.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5495.7,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5495.7,100,,4396.56,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5770.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15091.12,100,MS-DRG,12072.896,other,100% UHC DRG rate for inpatient setting,15091.12,100,MS-DRG,12072.896,other,100% UHC DRG rate for inpatient setting,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5605.62,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17885.44,100,MS-DRG,14308.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5495.7,23251.07,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15892.75,130,MS-DRG,12714.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5359.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5359.65,100,,4287.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5627.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9025.54,100,MS-DRG,7220.432,other,100% UHC DRG rate for inpatient setting,9025.54,100,MS-DRG,7220.432,other,100% UHC DRG rate for inpatient setting,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5466.84,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12225.19,100,MS-DRG,9780.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5359.65,15892.75,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12648.25,130,MS-DRG,10118.6,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2358.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2358.56,100,,1886.848,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2476.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6351.06,100,MS-DRG,5080.848,other,100% UHC DRG rate for inpatient setting,6351.06,100,MS-DRG,5080.848,other,100% UHC DRG rate for inpatient setting,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2405.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9729.42,100,MS-DRG,7783.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2358.56,12648.25,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29971.94,130,MS-DRG,23977.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8488.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8488.57,100,,6790.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8912.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20631.23,100,MS-DRG,16504.984,other,100% UHC DRG rate for inpatient setting,20631.23,100,MS-DRG,16504.984,other,100% UHC DRG rate for inpatient setting,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8658.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23055.34,100,MS-DRG,18444.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8488.57,29971.94,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16982.94,130,MS-DRG,13586.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4443.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4443.13,100,,3554.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4665.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9924.21,100,MS-DRG,7939.368,other,100% UHC DRG rate for inpatient setting,9924.21,100,MS-DRG,7939.368,other,100% UHC DRG rate for inpatient setting,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4532,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13063.8,100,MS-DRG,10451.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4443.13,16982.94,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13208.39,130,MS-DRG,10566.712,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2998.47,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2998.47,100,,2398.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3148.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6730.89,100,MS-DRG,5384.712,other,100% UHC DRG rate for inpatient setting,6730.89,100,MS-DRG,5384.712,other,100% UHC DRG rate for inpatient setting,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3058.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10160.3,100,MS-DRG,8128.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2998.47,13208.39,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24516.93,130,MS-DRG,19613.544,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5010.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5010.53,100,,4008.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5261.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16134.6,100,MS-DRG,12907.68,other,100% UHC DRG rate for inpatient setting,16134.6,100,MS-DRG,12907.68,other,100% UHC DRG rate for inpatient setting,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5110.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18859.18,100,MS-DRG,15087.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5010.53,24516.93,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17052.2,130,MS-DRG,13641.76,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5010.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5010.53,100,,4008.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5261.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9981.31,100,MS-DRG,7985.048,other,100% UHC DRG rate for inpatient setting,9981.31,100,MS-DRG,7985.048,other,100% UHC DRG rate for inpatient setting,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5110.74,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13117.08,100,MS-DRG,10493.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5010.53,17052.2,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14415.05,130,MS-DRG,11532.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2827.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2827.65,100,,2262.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2969.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7619.62,100,MS-DRG,6095.696,other,100% UHC DRG rate for inpatient setting,7619.62,100,MS-DRG,6095.696,other,100% UHC DRG rate for inpatient setting,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2884.21,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11088.5,100,MS-DRG,8870.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2827.65,14415.05,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22028.37,130,MS-DRG,17622.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4145.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4145.61,100,,3316.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4352.89,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14083.22,100,MS-DRG,11266.576,other,100% UHC DRG rate for inpatient setting,14083.22,100,MS-DRG,11266.576,other,100% UHC DRG rate for inpatient setting,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4228.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16944.9,100,MS-DRG,13555.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4145.61,22028.37,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14643.93,130,MS-DRG,11715.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3370.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3370.76,100,,2696.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3539.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7996.13,100,MS-DRG,6396.904,other,100% UHC DRG rate for inpatient setting,7996.13,100,MS-DRG,6396.904,other,100% UHC DRG rate for inpatient setting,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3438.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11264.56,100,MS-DRG,9011.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3370.76,14643.93,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18510.82,130,MS-DRG,14808.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3181.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3181.25,100,,2545,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3340.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11183.66,100,MS-DRG,8946.928,other,100% UHC DRG rate for inpatient setting,11183.66,100,MS-DRG,8946.928,other,100% UHC DRG rate for inpatient setting,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3244.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14239.09,100,MS-DRG,11391.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3181.25,18510.82,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13193.35,130,MS-DRG,10554.68,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2978.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2978.29,100,,2382.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3127.2,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6800.4,100,MS-DRG,5440.32,other,100% UHC DRG rate for inpatient setting,6800.4,100,MS-DRG,5440.32,other,100% UHC DRG rate for inpatient setting,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3037.85,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10148.73,100,MS-DRG,8118.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2978.29,13193.35,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18987.67,130,MS-DRG,15190.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4272.32,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4272.32,100,,3417.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4485.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11576.73,100,MS-DRG,9261.384,other,100% UHC DRG rate for inpatient setting,11576.73,100,MS-DRG,9261.384,other,100% UHC DRG rate for inpatient setting,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4357.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14605.9,100,MS-DRG,11684.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4272.32,18987.67,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13219.44,130,MS-DRG,10575.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2828.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2828.03,100,,2262.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2969.43,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6821.91,100,MS-DRG,5457.528,other,100% UHC DRG rate for inpatient setting,6821.91,100,MS-DRG,5457.528,other,100% UHC DRG rate for inpatient setting,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2884.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10168.8,100,MS-DRG,8135.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2828.03,13219.44,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20571.76,130,MS-DRG,16457.408,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3707.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3707.53,100,,2966.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3892.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12882.52,100,MS-DRG,10306.016,other,100% UHC DRG rate for inpatient setting,12882.52,100,MS-DRG,10306.016,other,100% UHC DRG rate for inpatient setting,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3781.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15824.43,100,MS-DRG,12659.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3707.53,20571.76,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13761.54,130,MS-DRG,11009.232,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2913.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2913.25,100,,2330.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3058.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7268.76,100,MS-DRG,5815.008,other,100% UHC DRG rate for inpatient setting,7268.76,100,MS-DRG,5815.008,other,100% UHC DRG rate for inpatient setting,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2971.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10585.8,100,MS-DRG,8468.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2913.25,13761.54,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23520.11,130,MS-DRG,18816.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10825.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10825.82,100,,8660.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11367.11,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15312.89,100,MS-DRG,12250.312,other,100% UHC DRG rate for inpatient setting,15312.89,100,MS-DRG,12250.312,other,100% UHC DRG rate for inpatient setting,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11042.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18092.39,100,MS-DRG,14473.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10825.82,23520.11,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16308.34,130,MS-DRG,13046.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7576.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7576.17,100,,6060.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7954.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9368.13,100,MS-DRG,7494.504,other,100% UHC DRG rate for inpatient setting,9368.13,100,MS-DRG,7494.504,other,100% UHC DRG rate for inpatient setting,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7727.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12544.88,100,MS-DRG,10035.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7576.17,16308.34,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12775.74,130,MS-DRG,10220.592,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5602.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5602.6,100,,4482.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5882.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6456.16,100,MS-DRG,5164.928,other,100% UHC DRG rate for inpatient setting,6456.16,100,MS-DRG,5164.928,other,100% UHC DRG rate for inpatient setting,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5714.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9827.49,100,MS-DRG,7861.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5602.6,12775.74,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20209.36,130,MS-DRG,16167.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3617.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3617.83,100,,2894.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3798.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12583.79,100,MS-DRG,10067.032,other,100% UHC DRG rate for inpatient setting,12583.79,100,MS-DRG,10067.032,other,100% UHC DRG rate for inpatient setting,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3690.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15545.66,100,MS-DRG,12436.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3617.83,20209.36,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13934.19,130,MS-DRG,11147.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3201.43,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3201.43,100,,2561.144,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3361.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7411.09,100,MS-DRG,5928.872,other,100% UHC DRG rate for inpatient setting,7411.09,100,MS-DRG,5928.872,other,100% UHC DRG rate for inpatient setting,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3265.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10718.61,100,MS-DRG,8574.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3201.43,13934.19,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20622.94,130,MS-DRG,16498.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.05,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4239.05,100,,3391.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4451,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12924.72,100,MS-DRG,10339.776,other,100% UHC DRG rate for inpatient setting,12924.72,100,MS-DRG,10339.776,other,100% UHC DRG rate for inpatient setting,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4323.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15863.8,100,MS-DRG,12691.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.05,20622.94,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14976.21,130,MS-DRG,11980.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.05,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4239.05,100,,3391.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4451,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8270.04,100,MS-DRG,6616.032,other,100% UHC DRG rate for inpatient setting,8270.04,100,MS-DRG,6616.032,other,100% UHC DRG rate for inpatient setting,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4323.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11520.16,100,MS-DRG,9216.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.05,14976.21,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12477.6,130,MS-DRG,9982.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2170.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2170.17,100,,1736.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2278.68,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6210.39,100,MS-DRG,4968.312,other,100% UHC DRG rate for inpatient setting,6210.39,100,MS-DRG,4968.312,other,100% UHC DRG rate for inpatient setting,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2213.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9598.15,100,MS-DRG,7678.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2170.17,12477.6,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34278.53,130,MS-DRG,27422.824,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6128.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6128.89,100,,4903.112,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6435.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24181.21,100,MS-DRG,19344.968,other,100% UHC DRG rate for inpatient setting,24181.21,100,MS-DRG,19344.968,other,100% UHC DRG rate for inpatient setting,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6251.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26368.1,100,MS-DRG,21094.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6128.89,34278.53,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21927.97,130,MS-DRG,17542.376,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4554.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4554.52,100,,3643.616,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4782.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14000.47,100,MS-DRG,11200.376,other,100% UHC DRG rate for inpatient setting,14000.47,100,MS-DRG,11200.376,other,100% UHC DRG rate for inpatient setting,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4645.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16867.67,100,MS-DRG,13494.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4554.52,21927.97,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16383.64,130,MS-DRG,13106.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3396.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3396.17,100,,2716.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3565.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9430.19,100,MS-DRG,7544.152,other,100% UHC DRG rate for inpatient setting,9430.19,100,MS-DRG,7544.152,other,100% UHC DRG rate for inpatient setting,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3464.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12602.8,100,MS-DRG,10082.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3396.17,16383.64,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,67364.95,130,MS-DRG,53891.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10361.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10361.96,100,,8289.568,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10880.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,51454.78,100,MS-DRG,41163.824,other,100% UHC DRG rate for inpatient setting,51454.78,100,MS-DRG,41163.824,other,100% UHC DRG rate for inpatient setting,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10569.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,51819.19,100,MS-DRG,41455.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10361.96,67364.95,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39133.22,130,MS-DRG,31306.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8160.76,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8160.76,100,,6528.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8568.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28183,100,MS-DRG,22546.4,other,100% UHC DRG rate for inpatient setting,28183,100,MS-DRG,22546.4,other,100% UHC DRG rate for inpatient setting,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8323.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30102.48,100,MS-DRG,24081.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8160.76,39133.22,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25482.65,130,MS-DRG,20386.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5360.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5360.39,100,,4288.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5628.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16930.65,100,MS-DRG,13544.52,other,100% UHC DRG rate for inpatient setting,16930.65,100,MS-DRG,13544.52,other,100% UHC DRG rate for inpatient setting,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5467.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19602.04,100,MS-DRG,15681.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5360.39,25482.65,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,61994.26,130,MS-DRG,49595.408,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19069.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,19069.56,100,,15255.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20023.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47027.65,100,MS-DRG,37622.12,other,100% UHC DRG rate for inpatient setting,47027.65,100,MS-DRG,37622.12,other,100% UHC DRG rate for inpatient setting,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19450.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,47687.89,100,MS-DRG,38150.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19069.56,61994.26,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31536.97,130,MS-DRG,25229.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8497.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8497.91,100,,6798.328,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8922.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21921.3,100,MS-DRG,17537.04,other,100% UHC DRG rate for inpatient setting,21921.3,100,MS-DRG,17537.04,other,100% UHC DRG rate for inpatient setting,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8667.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24259.21,100,MS-DRG,19407.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8497.91,31536.97,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21110.83,130,MS-DRG,16888.664,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5604.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5604.1,100,,4483.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5884.3,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13326.89,100,MS-DRG,10661.512,other,100% UHC DRG rate for inpatient setting,13326.89,100,MS-DRG,10661.512,other,100% UHC DRG rate for inpatient setting,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5716.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16239.1,100,MS-DRG,12991.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5604.1,21110.83,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38494.77,130,MS-DRG,30795.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11457.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11457.14,100,,9165.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12029.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27656.71,100,MS-DRG,22125.368,other,100% UHC DRG rate for inpatient setting,27656.71,100,MS-DRG,22125.368,other,100% UHC DRG rate for inpatient setting,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11686.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29611.36,100,MS-DRG,23689.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11457.14,38494.77,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22477.09,130,MS-DRG,17981.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5154.44,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5154.44,100,,4123.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5412.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14453.12,100,MS-DRG,11562.496,other,100% UHC DRG rate for inpatient setting,14453.12,100,MS-DRG,11562.496,other,100% UHC DRG rate for inpatient setting,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5257.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17290.07,100,MS-DRG,13832.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5154.44,22477.09,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18462.63,130,MS-DRG,14770.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3676.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3676.14,100,,2940.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3859.94,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11143.94,100,MS-DRG,8915.152,other,100% UHC DRG rate for inpatient setting,11143.94,100,MS-DRG,8915.152,other,100% UHC DRG rate for inpatient setting,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3749.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14202.02,100,MS-DRG,11361.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3676.14,18462.63,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22423.88,130,MS-DRG,17939.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5744.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5744.64,100,,4595.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6031.87,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13795.25,100,MS-DRG,11036.2,other,100% UHC DRG rate for inpatient setting,13795.25,100,MS-DRG,11036.2,other,100% UHC DRG rate for inpatient setting,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5859.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17249.14,100,MS-DRG,13799.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5744.64,22423.88,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20221.41,130,MS-DRG,16177.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5387.68,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5387.68,100,,4310.144,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5657.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12593.72,100,MS-DRG,10074.976,other,100% UHC DRG rate for inpatient setting,12593.72,100,MS-DRG,10074.976,other,100% UHC DRG rate for inpatient setting,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5495.43,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15554.93,100,MS-DRG,12443.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5387.68,20221.41,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24605.3,130,MS-DRG,19684.24,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6396.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6396.51,100,,5117.208,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6716.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16207.42,100,MS-DRG,12965.936,other,100% UHC DRG rate for inpatient setting,16207.42,100,MS-DRG,12965.936,other,100% UHC DRG rate for inpatient setting,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6524.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18927.15,100,MS-DRG,15141.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6396.51,24605.3,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21848.66,130,MS-DRG,17478.928,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5736.42,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5736.42,100,,4589.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6023.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13935.1,100,MS-DRG,11148.08,other,100% UHC DRG rate for inpatient setting,13935.1,100,MS-DRG,11148.08,other,100% UHC DRG rate for inpatient setting,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5851.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16806.66,100,MS-DRG,13445.328,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5736.42,21848.66,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25925.37,130,MS-DRG,20740.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5393.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5393.66,100,,4314.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5663.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17295.58,100,MS-DRG,13836.464,other,100% UHC DRG rate for inpatient setting,17295.58,100,MS-DRG,13836.464,other,100% UHC DRG rate for inpatient setting,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5501.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19942.59,100,MS-DRG,15954.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5393.66,25925.37,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17089.36,130,MS-DRG,13671.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3792.01,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3792.01,100,,3033.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3981.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10011.92,100,MS-DRG,8009.536,other,100% UHC DRG rate for inpatient setting,10011.92,100,MS-DRG,8009.536,other,100% UHC DRG rate for inpatient setting,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3867.85,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13145.66,100,MS-DRG,10516.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3792.01,17089.36,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12848.02,130,MS-DRG,10278.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1880.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1880.12,100,,1504.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1974.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6515.74,100,MS-DRG,5212.592,other,100% UHC DRG rate for inpatient setting,6515.74,100,MS-DRG,5212.592,other,100% UHC DRG rate for inpatient setting,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1917.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9883.09,100,MS-DRG,7906.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1880.12,12848.02,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26777.63,130,MS-DRG,21422.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5562.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5562.24,100,,4449.792,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5840.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17998.13,100,MS-DRG,14398.504,other,100% UHC DRG rate for inpatient setting,17998.13,100,MS-DRG,14398.504,other,100% UHC DRG rate for inpatient setting,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5673.48,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20598.18,100,MS-DRG,16478.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5562.24,26777.63,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15072.58,130,MS-DRG,12058.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3356.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3356.55,100,,2685.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3524.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8349.48,100,MS-DRG,6679.584,other,100% UHC DRG rate for inpatient setting,8349.48,100,MS-DRG,6679.584,other,100% UHC DRG rate for inpatient setting,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3423.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11594.29,100,MS-DRG,9275.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3356.55,15072.58,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21010.43,130,MS-DRG,16808.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4591.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4591.53,100,,3673.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4821.1,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13244.14,100,MS-DRG,10595.312,other,100% UHC DRG rate for inpatient setting,13244.14,100,MS-DRG,10595.312,other,100% UHC DRG rate for inpatient setting,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4683.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16161.87,100,MS-DRG,12929.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4591.53,21010.43,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16977.92,130,MS-DRG,13582.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3473.92,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3473.92,100,,2779.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3647.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9920.07,100,MS-DRG,7936.056,other,100% UHC DRG rate for inpatient setting,9920.07,100,MS-DRG,7936.056,other,100% UHC DRG rate for inpatient setting,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3543.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13059.94,100,MS-DRG,10447.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3473.92,16977.92,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11697.6,130,MS-DRG,9358.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3473.92,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3473.92,100,,2779.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3647.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5142.09,100,MS-DRG,4113.672,other,100% UHC DRG rate for inpatient setting,5142.09,100,MS-DRG,4113.672,other,100% UHC DRG rate for inpatient setting,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3543.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8998.15,100,MS-DRG,7198.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3473.92,11697.6,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15238.21,130,MS-DRG,12190.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3437.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3437.66,100,,2750.128,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3609.55,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8486.01,100,MS-DRG,6788.808,other,100% UHC DRG rate for inpatient setting,8486.01,100,MS-DRG,6788.808,other,100% UHC DRG rate for inpatient setting,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3506.42,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11721.7,100,MS-DRG,9377.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3437.66,15238.21,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11303.07,130,MS-DRG,9042.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2570.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2570.12,100,,2056.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2698.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5152.02,100,MS-DRG,4121.616,other,100% UHC DRG rate for inpatient setting,5152.02,100,MS-DRG,4121.616,other,100% UHC DRG rate for inpatient setting,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2621.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8694.67,100,MS-DRG,6955.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2570.12,11303.07,
CELLULITIS WITH MCC,602,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19876.08,130,MS-DRG,15900.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5104.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5104.73,100,,4083.784,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5359.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12309.06,100,MS-DRG,9847.248,other,100% UHC DRG rate for inpatient setting,12309.06,100,MS-DRG,9847.248,other,100% UHC DRG rate for inpatient setting,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5206.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15289.29,100,MS-DRG,12231.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5104.73,19876.08,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13824.77,130,MS-DRG,11059.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3302.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3302.36,100,,2641.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3467.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7320.89,100,MS-DRG,5856.712,other,100% UHC DRG rate for inpatient setting,7320.89,100,MS-DRG,5856.712,other,100% UHC DRG rate for inpatient setting,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3368.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10634.44,100,MS-DRG,8507.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3302.36,13824.77,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20063.8,130,MS-DRG,16051.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3633.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3633.9,100,,2907.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3815.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12463.81,100,MS-DRG,9971.048,other,100% UHC DRG rate for inpatient setting,12463.81,100,MS-DRG,9971.048,other,100% UHC DRG rate for inpatient setting,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3706.58,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15433.69,100,MS-DRG,12346.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3633.9,20063.8,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14066.7,130,MS-DRG,11253.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2607.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2607.12,100,,2085.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2737.48,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7520.32,100,MS-DRG,6016.256,other,100% UHC DRG rate for inpatient setting,7520.32,100,MS-DRG,6016.256,other,100% UHC DRG rate for inpatient setting,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2659.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10820.54,100,MS-DRG,8656.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2607.12,14066.7,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20862.87,130,MS-DRG,16690.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3418.23,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3418.23,100,,2734.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3589.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13122.5,100,MS-DRG,10498,other,100% UHC DRG rate for inpatient setting,13122.5,100,MS-DRG,10498,other,100% UHC DRG rate for inpatient setting,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3486.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16048.36,100,MS-DRG,12838.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3418.23,20862.87,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13913.12,130,MS-DRG,11130.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2590.68,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2590.68,100,,2072.544,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2720.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7393.71,100,MS-DRG,5914.968,other,100% UHC DRG rate for inpatient setting,7393.71,100,MS-DRG,5914.968,other,100% UHC DRG rate for inpatient setting,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2642.49,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10702.4,100,MS-DRG,8561.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2590.68,13913.12,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27554.63,130,MS-DRG,22043.704,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9741.85,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9741.85,100,,7793.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10228.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18638.61,100,MS-DRG,14910.888,other,100% UHC DRG rate for inpatient setting,18638.61,100,MS-DRG,14910.888,other,100% UHC DRG rate for inpatient setting,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9936.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21195.87,100,MS-DRG,16956.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9741.85,27554.63,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19711.45,130,MS-DRG,15769.16,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4792.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4792.25,100,,3833.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5031.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12173.35,100,MS-DRG,9738.68,other,100% UHC DRG rate for inpatient setting,12173.35,100,MS-DRG,9738.68,other,100% UHC DRG rate for inpatient setting,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4888.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15162.65,100,MS-DRG,12130.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4792.25,19711.45,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,44673.56,130,MS-DRG,35738.848,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12130.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12130.31,100,,9704.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12736.83,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32749.97,100,MS-DRG,26199.976,other,100% UHC DRG rate for inpatient setting,32749.97,100,MS-DRG,26199.976,other,100% UHC DRG rate for inpatient setting,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12372.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,34364.28,100,MS-DRG,27491.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12130.31,44673.56,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24865.28,130,MS-DRG,19892.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7013.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7013.63,100,,5610.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7364.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16421.74,100,MS-DRG,13137.392,other,100% UHC DRG rate for inpatient setting,16421.74,100,MS-DRG,13137.392,other,100% UHC DRG rate for inpatient setting,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7153.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19127.14,100,MS-DRG,15301.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7013.63,24865.28,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16603.48,130,MS-DRG,13282.784,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4958.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4958.95,100,,3967.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5206.9,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9611.41,100,MS-DRG,7689.128,other,100% UHC DRG rate for inpatient setting,9611.41,100,MS-DRG,7689.128,other,100% UHC DRG rate for inpatient setting,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5058.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12771.91,100,MS-DRG,10217.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4958.95,16603.48,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31069.18,130,MS-DRG,24855.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10263.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10263.65,100,,8210.92,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10776.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21419.84,100,MS-DRG,17135.872,other,100% UHC DRG rate for inpatient setting,21419.84,100,MS-DRG,17135.872,other,100% UHC DRG rate for inpatient setting,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10468.93,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23899.37,100,MS-DRG,19119.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10263.65,31069.18,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21228.29,130,MS-DRG,16982.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6600.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6600.22,100,,5280.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6930.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13423.71,100,MS-DRG,10738.968,other,100% UHC DRG rate for inpatient setting,13423.71,100,MS-DRG,10738.968,other,100% UHC DRG rate for inpatient setting,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6732.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16329.45,100,MS-DRG,13063.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6600.22,21228.29,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20175.23,130,MS-DRG,16140.184,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5309.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5309.56,100,,4247.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5575.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12555.66,100,MS-DRG,10044.528,other,100% UHC DRG rate for inpatient setting,12555.66,100,MS-DRG,10044.528,other,100% UHC DRG rate for inpatient setting,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5415.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15519.41,100,MS-DRG,12415.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5309.56,20175.23,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,43347.45,130,MS-DRG,34677.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12372.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12372.52,100,,9898.016,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12991.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31656.84,100,MS-DRG,25325.472,other,100% UHC DRG rate for inpatient setting,31656.84,100,MS-DRG,25325.472,other,100% UHC DRG rate for inpatient setting,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12619.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33344.19,100,MS-DRG,26675.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12372.52,43347.45,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23629.53,130,MS-DRG,18903.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6759.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6759.08,100,,5407.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7097.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15403.09,100,MS-DRG,12322.472,other,100% UHC DRG rate for inpatient setting,15403.09,100,MS-DRG,12322.472,other,100% UHC DRG rate for inpatient setting,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6894.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18176.56,100,MS-DRG,14541.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6759.08,23629.53,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16131.66,130,MS-DRG,12905.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2711.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2711.78,100,,2169.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2847.37,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9222.49,100,MS-DRG,7377.992,other,100% UHC DRG rate for inpatient setting,9222.49,100,MS-DRG,7377.992,other,100% UHC DRG rate for inpatient setting,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2766.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12408.97,100,MS-DRG,9927.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2711.78,16131.66,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34268.49,130,MS-DRG,27414.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7036.43,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7036.43,100,,5629.144,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7388.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24172.93,100,MS-DRG,19338.344,other,100% UHC DRG rate for inpatient setting,24172.93,100,MS-DRG,19338.344,other,100% UHC DRG rate for inpatient setting,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7177.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26360.38,100,MS-DRG,21088.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7036.43,34268.49,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19920.24,130,MS-DRG,15936.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5947.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5947.98,100,,4758.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6245.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12345.47,100,MS-DRG,9876.376,other,100% UHC DRG rate for inpatient setting,12345.47,100,MS-DRG,9876.376,other,100% UHC DRG rate for inpatient setting,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6066.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15323.26,100,MS-DRG,12258.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5947.98,19920.24,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17351.35,130,MS-DRG,13881.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4332.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4332.12,100,,3465.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4548.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10227.9,100,MS-DRG,8182.32,other,100% UHC DRG rate for inpatient setting,10227.9,100,MS-DRG,8182.32,other,100% UHC DRG rate for inpatient setting,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4418.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13347.19,100,MS-DRG,10677.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4332.12,17351.35,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,45243.74,130,MS-DRG,36194.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9036.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9036.16,100,,7228.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9487.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33219.99,100,MS-DRG,26575.992,other,100% UHC DRG rate for inpatient setting,33219.99,100,MS-DRG,26575.992,other,100% UHC DRG rate for inpatient setting,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9216.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,34802.88,100,MS-DRG,27842.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9036.16,45243.74,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27659.03,130,MS-DRG,22127.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9036.16,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9036.16,100,,7228.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9487.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18724.67,100,MS-DRG,14979.736,other,100% UHC DRG rate for inpatient setting,18724.67,100,MS-DRG,14979.736,other,100% UHC DRG rate for inpatient setting,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9216.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21276.18,100,MS-DRG,17020.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9036.16,27659.03,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18960.55,130,MS-DRG,15168.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4479.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4479.39,100,,3583.512,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4703.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11554.38,100,MS-DRG,9243.504,other,100% UHC DRG rate for inpatient setting,11554.38,100,MS-DRG,9243.504,other,100% UHC DRG rate for inpatient setting,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4568.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14585.04,100,MS-DRG,11668.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4479.39,18960.55,
DIABETES WITH MCC,637,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19492.6,130,MS-DRG,15594.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5048.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5048.66,100,,4038.928,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5301.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11992.96,100,MS-DRG,9594.368,other,100% UHC DRG rate for inpatient setting,11992.96,100,MS-DRG,9594.368,other,100% UHC DRG rate for inpatient setting,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5149.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14994.31,100,MS-DRG,11995.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5048.66,19492.6,
DIABETES WITH CC,638,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13972.35,130,MS-DRG,11177.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2946.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2946.52,100,,2357.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3093.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7442.54,100,MS-DRG,5954.032,other,100% UHC DRG rate for inpatient setting,7442.54,100,MS-DRG,5954.032,other,100% UHC DRG rate for inpatient setting,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3005.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10747.96,100,MS-DRG,8598.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2946.52,13972.35,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11192.64,130,MS-DRG,8954.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2052.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2052.06,100,,1641.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2154.66,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5151.19,100,MS-DRG,4120.952,other,100% UHC DRG rate for inpatient setting,5151.19,100,MS-DRG,4120.952,other,100% UHC DRG rate for inpatient setting,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2093.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8609.72,100,MS-DRG,6887.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2052.06,11192.64,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18146.4,130,MS-DRG,14517.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3625.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3625.3,100,,2900.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3806.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10883.28,100,MS-DRG,8706.624,other,100% UHC DRG rate for inpatient setting,10883.28,100,MS-DRG,8706.624,other,100% UHC DRG rate for inpatient setting,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3697.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13958.77,100,MS-DRG,11167.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3625.3,18146.4,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12787.78,130,MS-DRG,10230.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2776.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2776.45,100,,2221.16,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2915.27,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6466.09,100,MS-DRG,5172.872,other,100% UHC DRG rate for inpatient setting,6466.09,100,MS-DRG,5172.872,other,100% UHC DRG rate for inpatient setting,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2831.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9836.75,100,MS-DRG,7869.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2776.45,12787.78,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18026.94,130,MS-DRG,14421.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3436.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3436.17,100,,2748.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3607.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10784.81,100,MS-DRG,8627.848,other,100% UHC DRG rate for inpatient setting,10784.81,100,MS-DRG,8627.848,other,100% UHC DRG rate for inpatient setting,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3504.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13866.88,100,MS-DRG,11093.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3436.17,18026.94,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21458.16,130,MS-DRG,17166.528,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6370.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6370.72,100,,5096.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6689.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13613.2,100,MS-DRG,10890.56,other,100% UHC DRG rate for inpatient setting,13613.2,100,MS-DRG,10890.56,other,100% UHC DRG rate for inpatient setting,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6498.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16506.28,100,MS-DRG,13205.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6370.72,21458.16,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15601.61,130,MS-DRG,12481.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3379.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3379.35,100,,2703.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3548.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8785.57,100,MS-DRG,7028.456,other,100% UHC DRG rate for inpatient setting,8785.57,100,MS-DRG,7028.456,other,100% UHC DRG rate for inpatient setting,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3446.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12001.24,100,MS-DRG,9600.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3379.35,15601.61,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12582,130,MS-DRG,10065.6,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2598.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2598.15,100,,2078.52,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2728.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6296.45,100,MS-DRG,5037.16,other,100% UHC DRG rate for inpatient setting,6296.45,100,MS-DRG,5037.16,other,100% UHC DRG rate for inpatient setting,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2650.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9678.46,100,MS-DRG,7742.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2598.15,12582,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,50092.43,130,MS-DRG,40073.944,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5444.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5444.12,100,,4355.296,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5716.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37216.81,100,MS-DRG,29773.448,other,100% UHC DRG rate for inpatient setting,37216.81,100,MS-DRG,29773.448,other,100% UHC DRG rate for inpatient setting,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5553,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38532.64,100,MS-DRG,30826.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5444.12,50092.43,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39661.25,130,MS-DRG,31729,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32137.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,32137.69,100,,25710.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33744.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28618.26,100,MS-DRG,22894.608,other,100% UHC DRG rate for inpatient setting,28618.26,100,MS-DRG,22894.608,other,100% UHC DRG rate for inpatient setting,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32780.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30508.65,100,MS-DRG,24406.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28618.26,39661.25,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35103.71,130,MS-DRG,28082.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51633.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,51633.36,100,,41306.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,54215.03,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24861.41,100,MS-DRG,19889.128,other,100% UHC DRG rate for inpatient setting,24861.41,100,MS-DRG,19889.128,other,100% UHC DRG rate for inpatient setting,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,52666.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27002.85,100,MS-DRG,21602.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24861.41,54215.03,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,59288.83,130,MS-DRG,47431.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17864.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,17864.12,100,,14291.296,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18757.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,44797.54,100,MS-DRG,35838.032,other,100% UHC DRG rate for inpatient setting,44797.54,100,MS-DRG,35838.032,other,100% UHC DRG rate for inpatient setting,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18221.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,45606.79,100,MS-DRG,36485.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17864.12,59288.83,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32424.38,130,MS-DRG,25939.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8183.19,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8183.19,100,,6546.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8592.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22652.81,100,MS-DRG,18122.248,other,100% UHC DRG rate for inpatient setting,22652.81,100,MS-DRG,18122.248,other,100% UHC DRG rate for inpatient setting,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8346.85,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24941.83,100,MS-DRG,19953.464,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8183.19,32424.38,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26103.06,130,MS-DRG,20882.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6744.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6744.13,100,,5395.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7081.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17442.05,100,MS-DRG,13953.64,other,100% UHC DRG rate for inpatient setting,17442.05,100,MS-DRG,13953.64,other,100% UHC DRG rate for inpatient setting,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6879.01,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20079.28,100,MS-DRG,16063.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6744.13,26103.06,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,36440.86,130,MS-DRG,29152.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10173.2,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10173.2,100,,8138.56,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10681.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25963.64,100,MS-DRG,20770.912,other,100% UHC DRG rate for inpatient setting,25963.64,100,MS-DRG,20770.912,other,100% UHC DRG rate for inpatient setting,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10376.66,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28031.43,100,MS-DRG,22425.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10173.2,36440.86,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23456.85,130,MS-DRG,18765.48,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8888.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8888.51,100,,7110.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9332.94,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15260.76,100,MS-DRG,12208.608,other,100% UHC DRG rate for inpatient setting,15260.76,100,MS-DRG,12208.608,other,100% UHC DRG rate for inpatient setting,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9066.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18043.73,100,MS-DRG,14434.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8888.51,23456.85,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19804.8,130,MS-DRG,15843.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6645.45,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6645.45,100,,5316.36,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6977.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12250.31,100,MS-DRG,9800.248,other,100% UHC DRG rate for inpatient setting,12250.31,100,MS-DRG,9800.248,other,100% UHC DRG rate for inpatient setting,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6778.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15234.46,100,MS-DRG,12187.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6645.45,19804.8,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30932.64,130,MS-DRG,24746.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9396.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9396.11,100,,7516.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9865.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21423.15,100,MS-DRG,17138.52,other,100% UHC DRG rate for inpatient setting,21423.15,100,MS-DRG,17138.52,other,100% UHC DRG rate for inpatient setting,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9584.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23794.34,100,MS-DRG,19035.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9396.11,30932.64,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18454.59,130,MS-DRG,14763.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5133.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5133.51,100,,4106.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5390.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11137.32,100,MS-DRG,8909.856,other,100% UHC DRG rate for inpatient setting,11137.32,100,MS-DRG,8909.856,other,100% UHC DRG rate for inpatient setting,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5236.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14195.84,100,MS-DRG,11356.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5133.51,18454.59,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15468.1,130,MS-DRG,12374.48,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4554.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4554.15,100,,3643.32,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4781.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8675.51,100,MS-DRG,6940.408,other,100% UHC DRG rate for inpatient setting,8675.51,100,MS-DRG,6940.408,other,100% UHC DRG rate for inpatient setting,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4645.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11898.54,100,MS-DRG,9518.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4554.15,15468.1,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35026.42,130,MS-DRG,28021.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12815.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12815.46,100,,10252.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13456.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24797.69,100,MS-DRG,19838.152,other,100% UHC DRG rate for inpatient setting,24797.69,100,MS-DRG,19838.152,other,100% UHC DRG rate for inpatient setting,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13071.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26943.4,100,MS-DRG,21554.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12815.46,35026.42,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19589.99,130,MS-DRG,15671.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4946.62,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4946.62,100,,3957.296,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5193.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12073.23,100,MS-DRG,9658.584,other,100% UHC DRG rate for inpatient setting,12073.23,100,MS-DRG,9658.584,other,100% UHC DRG rate for inpatient setting,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5045.55,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15069.22,100,MS-DRG,12055.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4946.62,19589.99,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15600.61,130,MS-DRG,12480.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3804.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3804.72,100,,3043.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3994.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8784.74,100,MS-DRG,7027.792,other,100% UHC DRG rate for inpatient setting,8784.74,100,MS-DRG,7027.792,other,100% UHC DRG rate for inpatient setting,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3880.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12000.47,100,MS-DRG,9600.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3804.72,15600.61,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35954,130,MS-DRG,28763.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9725.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9725.03,100,,7780.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10211.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25562.3,100,MS-DRG,20449.84,other,100% UHC DRG rate for inpatient setting,25562.3,100,MS-DRG,20449.84,other,100% UHC DRG rate for inpatient setting,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9919.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27656.92,100,MS-DRG,22125.536,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9725.03,35954,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22183.97,130,MS-DRG,17747.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6332.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6332.22,100,,5065.776,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6648.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14211.49,100,MS-DRG,11369.192,other,100% UHC DRG rate for inpatient setting,14211.49,100,MS-DRG,11369.192,other,100% UHC DRG rate for inpatient setting,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6458.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17064.59,100,MS-DRG,13651.672,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6332.22,22183.97,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15480.14,130,MS-DRG,12384.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3720.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3720.24,100,,2976.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3906.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8685.44,100,MS-DRG,6948.352,other,100% UHC DRG rate for inpatient setting,8685.44,100,MS-DRG,6948.352,other,100% UHC DRG rate for inpatient setting,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3794.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11907.8,100,MS-DRG,9526.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3720.24,15480.14,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33232.51,130,MS-DRG,26586.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9308.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9308.64,100,,7446.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9774.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23318.95,100,MS-DRG,18655.16,other,100% UHC DRG rate for inpatient setting,23318.95,100,MS-DRG,18655.16,other,100% UHC DRG rate for inpatient setting,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9494.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25563.47,100,MS-DRG,20450.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9308.64,33232.51,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20348.9,130,MS-DRG,16279.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4279.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4279.04,100,,3423.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4493,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12698.82,100,MS-DRG,10159.056,other,100% UHC DRG rate for inpatient setting,12698.82,100,MS-DRG,10159.056,other,100% UHC DRG rate for inpatient setting,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4364.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15653,100,MS-DRG,12522.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4279.04,20348.9,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14606.79,130,MS-DRG,11685.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2882.97,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2882.97,100,,2306.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3027.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7965.52,100,MS-DRG,6372.416,other,100% UHC DRG rate for inpatient setting,7965.52,100,MS-DRG,6372.416,other,100% UHC DRG rate for inpatient setting,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2940.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11235.99,100,MS-DRG,8988.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2882.97,14606.79,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22128.76,130,MS-DRG,17703.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5140.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5140.24,100,,4112.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5397.25,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14165.97,100,MS-DRG,11332.776,other,100% UHC DRG rate for inpatient setting,14165.97,100,MS-DRG,11332.776,other,100% UHC DRG rate for inpatient setting,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5243.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17022.12,100,MS-DRG,13617.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5140.24,22128.76,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14354.82,130,MS-DRG,11483.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4479.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4479.02,100,,3583.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4702.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7635.34,100,MS-DRG,6108.272,other,100% UHC DRG rate for inpatient setting,7635.34,100,MS-DRG,6108.272,other,100% UHC DRG rate for inpatient setting,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4568.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11042.17,100,MS-DRG,8833.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4479.02,14354.82,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42066.52,130,MS-DRG,33653.216,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9928.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9928.74,100,,7942.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10425.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30600.95,100,MS-DRG,24480.76,other,100% UHC DRG rate for inpatient setting,30600.95,100,MS-DRG,24480.76,other,100% UHC DRG rate for inpatient setting,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10127.32,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32358.86,100,MS-DRG,25887.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9928.74,42066.52,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28857.66,130,MS-DRG,23086.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9566.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9566.55,100,,7653.24,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10044.88,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19712.71,100,MS-DRG,15770.168,other,100% UHC DRG rate for inpatient setting,19712.71,100,MS-DRG,15770.168,other,100% UHC DRG rate for inpatient setting,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9757.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22198.2,100,MS-DRG,17758.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9566.55,28857.66,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20869.9,130,MS-DRG,16695.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4887.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4887.56,100,,3910.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5131.94,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13128.29,100,MS-DRG,10502.632,other,100% UHC DRG rate for inpatient setting,13128.29,100,MS-DRG,10502.632,other,100% UHC DRG rate for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4985.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16053.77,100,MS-DRG,12843.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4887.56,20869.9,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20009.57,130,MS-DRG,16007.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4952.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4952.6,100,,3962.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5200.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12419.12,100,MS-DRG,9935.296,other,100% UHC DRG rate for inpatient setting,12419.12,100,MS-DRG,9935.296,other,100% UHC DRG rate for inpatient setting,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5051.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15391.98,100,MS-DRG,12313.584,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4952.6,20009.57,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13986.4,130,MS-DRG,11189.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3492.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3492.61,100,,2794.088,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3667.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7454.12,100,MS-DRG,5963.296,other,100% UHC DRG rate for inpatient setting,7454.12,100,MS-DRG,5963.296,other,100% UHC DRG rate for inpatient setting,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3562.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10758.77,100,MS-DRG,8607.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3492.61,13986.4,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11052.09,130,MS-DRG,8841.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2165.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2165.31,100,,1732.248,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2273.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5035.34,100,MS-DRG,4028.272,other,100% UHC DRG rate for inpatient setting,5035.34,100,MS-DRG,4028.272,other,100% UHC DRG rate for inpatient setting,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2208.62,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8501.61,100,MS-DRG,6801.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2165.31,11052.09,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23408.68,130,MS-DRG,18726.944,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3882.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3882.84,100,,3106.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4076.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15221.04,100,MS-DRG,12176.832,other,100% UHC DRG rate for inpatient setting,15221.04,100,MS-DRG,12176.832,other,100% UHC DRG rate for inpatient setting,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3960.49,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18006.68,100,MS-DRG,14405.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3882.84,23408.68,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15436.99,130,MS-DRG,12349.592,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3020.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3020.15,100,,2416.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3171.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8649.86,100,MS-DRG,6919.888,other,100% UHC DRG rate for inpatient setting,8649.86,100,MS-DRG,6919.888,other,100% UHC DRG rate for inpatient setting,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3080.55,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11874.61,100,MS-DRG,9499.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3020.15,15436.99,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12782.76,130,MS-DRG,10226.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1965.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1965.34,100,,1572.272,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2063.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6461.95,100,MS-DRG,5169.56,other,100% UHC DRG rate for inpatient setting,6461.95,100,MS-DRG,5169.56,other,100% UHC DRG rate for inpatient setting,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2004.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9832.89,100,MS-DRG,7866.312,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1965.34,12782.76,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16732.98,130,MS-DRG,13386.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4119.07,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4119.07,100,,3295.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4325.02,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9718.16,100,MS-DRG,7774.528,other,100% UHC DRG rate for inpatient setting,9718.16,100,MS-DRG,7774.528,other,100% UHC DRG rate for inpatient setting,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4201.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12871.52,100,MS-DRG,10297.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4119.07,16732.98,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13043.77,130,MS-DRG,10435.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2918.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2918.11,100,,2334.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3064.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6677.1,100,MS-DRG,5341.68,other,100% UHC DRG rate for inpatient setting,6677.1,100,MS-DRG,5341.68,other,100% UHC DRG rate for inpatient setting,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2976.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10033.67,100,MS-DRG,8026.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2918.11,13043.77,
URINARY STONES WITH MCC,693,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19161.34,130,MS-DRG,15329.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3573.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3573.72,100,,2858.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3752.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11719.88,100,MS-DRG,9375.904,other,100% UHC DRG rate for inpatient setting,11719.88,100,MS-DRG,9375.904,other,100% UHC DRG rate for inpatient setting,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3645.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14739.49,100,MS-DRG,11791.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3573.72,19161.34,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12800.83,130,MS-DRG,10240.664,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2742.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2742.06,100,,2193.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2879.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6476.84,100,MS-DRG,5181.472,other,100% UHC DRG rate for inpatient setting,6476.84,100,MS-DRG,5181.472,other,100% UHC DRG rate for inpatient setting,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2796.9,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9846.79,100,MS-DRG,7877.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2742.06,12800.83,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16949.8,130,MS-DRG,13559.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3605.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3605.49,100,,2884.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3785.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9896.9,100,MS-DRG,7917.52,other,100% UHC DRG rate for inpatient setting,9896.9,100,MS-DRG,7917.52,other,100% UHC DRG rate for inpatient setting,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3677.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13038.31,100,MS-DRG,10430.648,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3605.49,16949.8,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11891.33,130,MS-DRG,9513.064,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1942.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1942.54,100,,1554.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2039.67,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5727.13,100,MS-DRG,4581.704,other,100% UHC DRG rate for inpatient setting,5727.13,100,MS-DRG,4581.704,other,100% UHC DRG rate for inpatient setting,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1981.39,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9147.18,100,MS-DRG,7317.744,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1942.54,11891.33,
URETHRAL STRICTURE,697,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16117.6,130,MS-DRG,12894.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2274.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2274.08,100,,1819.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2387.79,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9210.9,100,MS-DRG,7368.72,other,100% UHC DRG rate for inpatient setting,9210.9,100,MS-DRG,7368.72,other,100% UHC DRG rate for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2319.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12398.15,100,MS-DRG,9918.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2274.08,16117.6,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21551.53,130,MS-DRG,17241.224,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5171.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5171.26,100,,4137.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5429.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13690.16,100,MS-DRG,10952.128,other,100% UHC DRG rate for inpatient setting,13690.16,100,MS-DRG,10952.128,other,100% UHC DRG rate for inpatient setting,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5274.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16578.1,100,MS-DRG,13262.48,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5171.26,21551.53,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15191.05,130,MS-DRG,12152.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3678.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3678.38,100,,2942.704,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3862.3,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8447.12,100,MS-DRG,6757.696,other,100% UHC DRG rate for inpatient setting,8447.12,100,MS-DRG,6757.696,other,100% UHC DRG rate for inpatient setting,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3751.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11685.42,100,MS-DRG,9348.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3678.38,15191.05,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12053.96,130,MS-DRG,9643.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2602.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2602.26,100,,2081.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2732.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5861.18,100,MS-DRG,4688.944,other,100% UHC DRG rate for inpatient setting,5861.18,100,MS-DRG,4688.944,other,100% UHC DRG rate for inpatient setting,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2654.31,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9272.28,100,MS-DRG,7417.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2602.26,12053.96,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24638.42,130,MS-DRG,19710.736,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7098.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7098.1,100,,5678.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7453.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16234.72,100,MS-DRG,12987.776,other,100% UHC DRG rate for inpatient setting,16234.72,100,MS-DRG,12987.776,other,100% UHC DRG rate for inpatient setting,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7240.06,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18952.63,100,MS-DRG,15162.104,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7098.1,24638.42,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19584.96,130,MS-DRG,15667.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4308.2,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4308.2,100,,3446.56,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4523.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12069.09,100,MS-DRG,9655.272,other,100% UHC DRG rate for inpatient setting,12069.09,100,MS-DRG,9655.272,other,100% UHC DRG rate for inpatient setting,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4394.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15065.35,100,MS-DRG,12052.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4308.2,19584.96,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26735.49,130,MS-DRG,21388.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5639.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5639.98,100,,4511.984,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5921.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17543,100,MS-DRG,14034.4,other,100% UHC DRG rate for inpatient setting,17543,100,MS-DRG,14034.4,other,100% UHC DRG rate for inpatient setting,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5752.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20565.76,100,MS-DRG,16452.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5639.98,26735.49,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17966.73,130,MS-DRG,14373.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3597.64,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3597.64,100,,2878.112,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3777.52,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10213.83,100,MS-DRG,8171.064,other,100% UHC DRG rate for inpatient setting,10213.83,100,MS-DRG,8171.064,other,100% UHC DRG rate for inpatient setting,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3669.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13820.56,100,MS-DRG,11056.448,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3597.64,17966.73,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26254.63,130,MS-DRG,21003.704,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6962.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6962.04,100,,5569.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7310.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17567,100,MS-DRG,14053.6,other,100% UHC DRG rate for inpatient setting,17567,100,MS-DRG,14053.6,other,100% UHC DRG rate for inpatient setting,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7101.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20195.87,100,MS-DRG,16156.696,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6962.04,26254.63,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16873.52,130,MS-DRG,13498.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4048.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4048.8,100,,3239.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4251.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9834.01,100,MS-DRG,7867.208,other,100% UHC DRG rate for inpatient setting,9834.01,100,MS-DRG,7867.208,other,100% UHC DRG rate for inpatient setting,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4129.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12979.63,100,MS-DRG,10383.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4048.8,16873.52,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19506.66,130,MS-DRG,15605.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5040.81,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5040.81,100,,4032.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5292.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12004.54,100,MS-DRG,9603.632,other,100% UHC DRG rate for inpatient setting,12004.54,100,MS-DRG,9603.632,other,100% UHC DRG rate for inpatient setting,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5141.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15005.12,100,MS-DRG,12004.096,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5040.81,19506.66,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14565.62,130,MS-DRG,11652.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2949.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2949.51,100,,2359.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3096.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7931.59,100,MS-DRG,6345.272,other,100% UHC DRG rate for inpatient setting,7931.59,100,MS-DRG,6345.272,other,100% UHC DRG rate for inpatient setting,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3008.5,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11204.32,100,MS-DRG,8963.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2949.51,14565.62,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27103.92,130,MS-DRG,21683.136,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9152.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9152.78,100,,7322.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9610.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18267.06,100,MS-DRG,14613.648,other,100% UHC DRG rate for inpatient setting,18267.06,100,MS-DRG,14613.648,other,100% UHC DRG rate for inpatient setting,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9335.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20849.17,100,MS-DRG,16679.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9152.78,27103.92,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19220.55,130,MS-DRG,15376.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8283.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8283.36,100,,6626.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8697.53,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11768.71,100,MS-DRG,9414.968,other,100% UHC DRG rate for inpatient setting,11768.71,100,MS-DRG,9414.968,other,100% UHC DRG rate for inpatient setting,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8449.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14785.04,100,MS-DRG,11828.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8283.36,19220.55,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23150.67,130,MS-DRG,18520.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5661.29,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5661.29,100,,4529.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5944.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15008.37,100,MS-DRG,12006.696,other,100% UHC DRG rate for inpatient setting,15008.37,100,MS-DRG,12006.696,other,100% UHC DRG rate for inpatient setting,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5774.51,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17808.21,100,MS-DRG,14246.568,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5661.29,23150.67,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16747.03,130,MS-DRG,13397.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5243.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5243.77,100,,4195.016,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5505.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9729.75,100,MS-DRG,7783.8,other,100% UHC DRG rate for inpatient setting,9729.75,100,MS-DRG,7783.8,other,100% UHC DRG rate for inpatient setting,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5348.65,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12882.33,100,MS-DRG,10305.864,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5243.77,16747.03,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23764.04,130,MS-DRG,19011.232,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7306.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7306.3,100,,5845.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7671.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15513.97,100,MS-DRG,12411.176,other,100% UHC DRG rate for inpatient setting,15513.97,100,MS-DRG,12411.176,other,100% UHC DRG rate for inpatient setting,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7452.42,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18280.03,100,MS-DRG,14624.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7306.3,23764.04,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16129.65,130,MS-DRG,12903.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3053.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3053.04,100,,2442.432,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3205.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9220.83,100,MS-DRG,7376.664,other,100% UHC DRG rate for inpatient setting,9220.83,100,MS-DRG,7376.664,other,100% UHC DRG rate for inpatient setting,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3114.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12407.42,100,MS-DRG,9925.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3053.04,16129.65,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13069.86,130,MS-DRG,10455.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3053.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3053.04,100,,2442.432,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3205.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6698.61,100,MS-DRG,5358.888,other,100% UHC DRG rate for inpatient setting,6698.61,100,MS-DRG,5358.888,other,100% UHC DRG rate for inpatient setting,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3114.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10053.74,100,MS-DRG,8042.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3053.04,13069.86,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17400.54,130,MS-DRG,13920.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2970.81,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2970.81,100,,2376.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3119.35,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10268.45,100,MS-DRG,8214.76,other,100% UHC DRG rate for inpatient setting,10268.45,100,MS-DRG,8214.76,other,100% UHC DRG rate for inpatient setting,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3030.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13385.03,100,MS-DRG,10708.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2970.81,17400.54,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12280.84,130,MS-DRG,9824.672,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2132.05,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2132.05,100,,1705.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2238.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6048.2,100,MS-DRG,4838.56,other,100% UHC DRG rate for inpatient setting,6048.2,100,MS-DRG,4838.56,other,100% UHC DRG rate for inpatient setting,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2174.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9446.8,100,MS-DRG,7557.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2132.05,12280.84,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21216.23,130,MS-DRG,16972.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3460.84,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3460.84,100,,2768.672,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3633.88,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13413.78,100,MS-DRG,10731.024,other,100% UHC DRG rate for inpatient setting,13413.78,100,MS-DRG,10731.024,other,100% UHC DRG rate for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3530.06,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16320.18,100,MS-DRG,13056.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3460.84,21216.23,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12975.5,130,MS-DRG,10380.4,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3110.61,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3110.61,100,,2488.488,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3266.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6620.83,100,MS-DRG,5296.664,other,100% UHC DRG rate for inpatient setting,6620.83,100,MS-DRG,5296.664,other,100% UHC DRG rate for inpatient setting,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3172.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9981.15,100,MS-DRG,7984.92,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3110.61,12975.5,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15021.38,130,MS-DRG,12017.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3232.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3232.08,100,,2585.664,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3393.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8307.27,100,MS-DRG,6645.816,other,100% UHC DRG rate for inpatient setting,8307.27,100,MS-DRG,6645.816,other,100% UHC DRG rate for inpatient setting,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3296.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11554.91,100,MS-DRG,9243.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3232.08,15021.38,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11183.6,130,MS-DRG,8946.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2024.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2024.02,100,,1619.216,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2125.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5143.74,100,MS-DRG,4114.992,other,100% UHC DRG rate for inpatient setting,5143.74,100,MS-DRG,4114.992,other,100% UHC DRG rate for inpatient setting,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2064.5,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8602.77,100,MS-DRG,6882.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2024.02,11183.6,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26763.59,130,MS-DRG,21410.872,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7119.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7119.78,100,,5695.824,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7475.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17986.54,100,MS-DRG,14389.232,other,100% UHC DRG rate for inpatient setting,17986.54,100,MS-DRG,14389.232,other,100% UHC DRG rate for inpatient setting,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7262.18,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20587.38,100,MS-DRG,16469.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7119.78,26763.59,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17594.29,130,MS-DRG,14075.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4712.63,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4712.63,100,,3770.104,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4948.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10428.16,100,MS-DRG,8342.528,other,100% UHC DRG rate for inpatient setting,10428.16,100,MS-DRG,8342.528,other,100% UHC DRG rate for inpatient setting,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4806.88,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13534.07,100,MS-DRG,10827.256,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4712.63,17594.29,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,43965.83,130,MS-DRG,35172.664,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10649.77,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10649.77,100,,8519.816,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11182.26,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32166.58,100,MS-DRG,25733.264,other,100% UHC DRG rate for inpatient setting,32166.58,100,MS-DRG,25733.264,other,100% UHC DRG rate for inpatient setting,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10862.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33819.87,100,MS-DRG,27055.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10649.77,43965.83,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,24757.88,130,MS-DRG,19806.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5967.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5967.04,100,,4773.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6265.39,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16333.2,100,MS-DRG,13066.56,other,100% UHC DRG rate for inpatient setting,16333.2,100,MS-DRG,13066.56,other,100% UHC DRG rate for inpatient setting,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6086.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19044.52,100,MS-DRG,15235.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5967.04,24757.88,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18642.33,130,MS-DRG,14913.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4491.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4491.73,100,,3593.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4716.31,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11292.07,100,MS-DRG,9033.656,other,100% UHC DRG rate for inpatient setting,11292.07,100,MS-DRG,9033.656,other,100% UHC DRG rate for inpatient setting,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4581.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14340.25,100,MS-DRG,11472.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4491.73,18642.33,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,41246.37,130,MS-DRG,32997.096,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9580.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9580.38,100,,7664.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10059.4,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29924.88,100,MS-DRG,23939.904,other,100% UHC DRG rate for inpatient setting,29924.88,100,MS-DRG,23939.904,other,100% UHC DRG rate for inpatient setting,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9771.99,102,,,other,102% GA Medicaid DRG rate for inpatient setting,31727.98,100,MS-DRG,25382.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9580.38,41246.37,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22882.65,130,MS-DRG,18306.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6710.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6710.49,100,,5368.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7046.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14787.43,100,MS-DRG,11829.944,other,100% UHC DRG rate for inpatient setting,14787.43,100,MS-DRG,11829.944,other,100% UHC DRG rate for inpatient setting,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6844.7,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17602.04,100,MS-DRG,14081.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6710.49,22882.65,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17986.81,130,MS-DRG,14389.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3641.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3641.37,100,,2913.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3823.44,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10751.71,100,MS-DRG,8601.368,other,100% UHC DRG rate for inpatient setting,10751.71,100,MS-DRG,8601.368,other,100% UHC DRG rate for inpatient setting,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3714.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13836.01,100,MS-DRG,11068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3641.37,17986.81,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22831.46,130,MS-DRG,18265.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4390.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4390.06,100,,3512.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4609.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14745.22,100,MS-DRG,11796.176,other,100% UHC DRG rate for inpatient setting,14745.22,100,MS-DRG,11796.176,other,100% UHC DRG rate for inpatient setting,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4477.86,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17562.66,100,MS-DRG,14050.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4390.06,22831.46,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16608.49,130,MS-DRG,13286.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3315.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3315.06,100,,2652.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3480.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9615.55,100,MS-DRG,7692.44,other,100% UHC DRG rate for inpatient setting,9615.55,100,MS-DRG,7692.44,other,100% UHC DRG rate for inpatient setting,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3381.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12775.76,100,MS-DRG,10220.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3315.06,16608.49,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23840.35,130,MS-DRG,19072.28,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4458.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4458.46,100,,3566.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4681.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15576.86,100,MS-DRG,12461.488,other,100% UHC DRG rate for inpatient setting,15576.86,100,MS-DRG,12461.488,other,100% UHC DRG rate for inpatient setting,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4547.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18338.73,100,MS-DRG,14670.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4458.46,23840.35,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15342.63,130,MS-DRG,12274.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2860.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2860.55,100,,2288.44,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3003.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8572.07,100,MS-DRG,6857.656,other,100% UHC DRG rate for inpatient setting,8572.07,100,MS-DRG,6857.656,other,100% UHC DRG rate for inpatient setting,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2917.76,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11802.02,100,MS-DRG,9441.616,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2860.55,15342.63,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21769.36,130,MS-DRG,17415.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4267.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4267.83,100,,3414.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4481.22,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13869.73,100,MS-DRG,11095.784,other,100% UHC DRG rate for inpatient setting,13869.73,100,MS-DRG,11095.784,other,100% UHC DRG rate for inpatient setting,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4353.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16745.66,100,MS-DRG,13396.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4267.83,21769.36,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13849.86,130,MS-DRG,11079.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3161.44,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3161.44,100,,2529.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3319.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7341.58,100,MS-DRG,5873.264,other,100% UHC DRG rate for inpatient setting,7341.58,100,MS-DRG,5873.264,other,100% UHC DRG rate for inpatient setting,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3224.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10653.74,100,MS-DRG,8522.992,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3161.44,13849.86,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19046.89,130,MS-DRG,15237.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3427.95,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3427.95,100,,2742.36,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3599.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11625.55,100,MS-DRG,9300.44,other,100% UHC DRG rate for inpatient setting,11625.55,100,MS-DRG,9300.44,other,100% UHC DRG rate for inpatient setting,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3496.5,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14651.45,100,MS-DRG,11721.16,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3427.95,19046.89,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30212.88,130,MS-DRG,24170.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7427.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7427.78,100,,5942.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7799.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20829.83,100,MS-DRG,16663.864,other,100% UHC DRG rate for inpatient setting,20829.83,100,MS-DRG,16663.864,other,100% UHC DRG rate for inpatient setting,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7576.33,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23240.68,100,MS-DRG,18592.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7427.78,30212.88,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18596.15,130,MS-DRG,14876.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4020.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4020.39,100,,3216.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4221.41,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11254,100,MS-DRG,9003.2,other,100% UHC DRG rate for inpatient setting,11254,100,MS-DRG,9003.2,other,100% UHC DRG rate for inpatient setting,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4100.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14304.73,100,MS-DRG,11443.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4020.39,18596.15,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23540.18,130,MS-DRG,18832.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4801.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4801.22,100,,3840.976,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5041.28,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15329.44,100,MS-DRG,12263.552,other,100% UHC DRG rate for inpatient setting,15329.44,100,MS-DRG,12263.552,other,100% UHC DRG rate for inpatient setting,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4897.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18107.83,100,MS-DRG,14486.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4801.22,23540.18,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15832.49,130,MS-DRG,12665.992,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4334.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4334.74,100,,3467.792,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4551.48,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8975.89,100,MS-DRG,7180.712,other,100% UHC DRG rate for inpatient setting,8975.89,100,MS-DRG,7180.712,other,100% UHC DRG rate for inpatient setting,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4421.43,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12178.84,100,MS-DRG,9743.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4334.74,15832.49,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14878.84,130,MS-DRG,11903.072,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2672.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2672.53,100,,2138.024,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2806.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8189.77,100,MS-DRG,6551.816,other,100% UHC DRG rate for inpatient setting,8189.77,100,MS-DRG,6551.816,other,100% UHC DRG rate for inpatient setting,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2725.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11445.26,100,MS-DRG,9156.208,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2672.53,14878.84,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19917.22,130,MS-DRG,15933.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3729.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3729.96,100,,2983.968,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3916.46,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12342.99,100,MS-DRG,9874.392,other,100% UHC DRG rate for inpatient setting,12342.99,100,MS-DRG,9874.392,other,100% UHC DRG rate for inpatient setting,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3804.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15320.94,100,MS-DRG,12256.752,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3729.96,19917.22,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14907.95,130,MS-DRG,11926.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3014.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3014.17,100,,2411.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3164.88,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8213.77,100,MS-DRG,6571.016,other,100% UHC DRG rate for inpatient setting,8213.77,100,MS-DRG,6571.016,other,100% UHC DRG rate for inpatient setting,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3074.45,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11467.65,100,MS-DRG,9174.12,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3014.17,14907.95,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11430.56,130,MS-DRG,9144.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2293.52,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2293.52,100,,1834.816,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2408.2,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5347.31,100,MS-DRG,4277.848,other,100% UHC DRG rate for inpatient setting,5347.31,100,MS-DRG,4277.848,other,100% UHC DRG rate for inpatient setting,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2339.39,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8792.74,100,MS-DRG,7034.192,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2293.52,11430.56,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14936.05,130,MS-DRG,11948.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2751.78,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2751.78,100,,2201.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2889.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8236.94,100,MS-DRG,6589.552,other,100% UHC DRG rate for inpatient setting,8236.94,100,MS-DRG,6589.552,other,100% UHC DRG rate for inpatient setting,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2806.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11489.27,100,MS-DRG,9191.416,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2751.78,14936.05,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11022.99,130,MS-DRG,8818.392,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2143.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2143.26,100,,1714.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2250.42,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5011.34,100,MS-DRG,4009.072,other,100% UHC DRG rate for inpatient setting,5011.34,100,MS-DRG,4009.072,other,100% UHC DRG rate for inpatient setting,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2186.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8479.22,100,MS-DRG,6783.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2143.26,11022.99,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17171.66,130,MS-DRG,13737.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3055.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3055.66,100,,2444.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3208.44,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10079.78,100,MS-DRG,8063.824,other,100% UHC DRG rate for inpatient setting,10079.78,100,MS-DRG,8063.824,other,100% UHC DRG rate for inpatient setting,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3116.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13208.97,100,MS-DRG,10567.176,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3055.66,17171.66,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20442.25,130,MS-DRG,16353.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4859.53,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4859.53,100,,3887.624,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5102.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12775.77,100,MS-DRG,10220.616,other,100% UHC DRG rate for inpatient setting,12775.77,100,MS-DRG,10220.616,other,100% UHC DRG rate for inpatient setting,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4956.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15724.81,100,MS-DRG,12579.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4859.53,20442.25,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12961.44,130,MS-DRG,10369.152,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2421.73,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2421.73,100,,1937.384,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2542.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6609.24,100,MS-DRG,5287.392,other,100% UHC DRG rate for inpatient setting,6609.24,100,MS-DRG,5287.392,other,100% UHC DRG rate for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2470.16,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9970.34,100,MS-DRG,7976.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2421.73,12961.44,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12138.28,130,MS-DRG,9710.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2424.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2424.34,100,,1939.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2545.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5930.69,100,MS-DRG,4744.552,other,100% UHC DRG rate for inpatient setting,5930.69,100,MS-DRG,4744.552,other,100% UHC DRG rate for inpatient setting,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2472.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9337.14,100,MS-DRG,7469.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2424.34,12138.28,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14873.81,130,MS-DRG,11899.048,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2007.2,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2007.2,100,,1605.76,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2107.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8185.63,100,MS-DRG,6548.504,other,100% UHC DRG rate for inpatient setting,8185.63,100,MS-DRG,6548.504,other,100% UHC DRG rate for inpatient setting,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2047.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11441.39,100,MS-DRG,9153.112,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2007.2,14873.81,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22730.06,130,MS-DRG,18184.048,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14661.65,100,MS-DRG,11729.32,other,100% UHC DRG rate for inpatient setting,14661.65,100,MS-DRG,11729.32,other,100% UHC DRG rate for inpatient setting,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,17484.66,100,MS-DRG,13987.728,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14661.65,22730.06,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15224.17,130,MS-DRG,12179.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8474.43,100,MS-DRG,6779.544,other,100% UHC DRG rate for inpatient setting,8474.43,100,MS-DRG,6779.544,other,100% UHC DRG rate for inpatient setting,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,11710.9,100,MS-DRG,9368.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8474.43,15224.17,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13640.07,130,MS-DRG,10912.056,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7168.63,100,MS-DRG,5734.904,other,100% UHC DRG rate for inpatient setting,7168.63,100,MS-DRG,5734.904,other,100% UHC DRG rate for inpatient setting,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,10492.36,100,MS-DRG,8393.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7168.63,13640.07,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22506.2,130,MS-DRG,18004.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14477.11,100,MS-DRG,11581.688,other,100% UHC DRG rate for inpatient setting,14477.11,100,MS-DRG,11581.688,other,100% UHC DRG rate for inpatient setting,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,17312.46,100,MS-DRG,13849.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14477.11,22506.2,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15495.21,130,MS-DRG,12396.168,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2667.67,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2667.67,100,,2134.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2801.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8697.85,100,MS-DRG,6958.28,other,100% UHC DRG rate for inpatient setting,8697.85,100,MS-DRG,6958.28,other,100% UHC DRG rate for inpatient setting,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2721.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11919.39,100,MS-DRG,9535.512,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2667.67,15495.21,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13526.62,130,MS-DRG,10821.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2898.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2898.3,100,,2318.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3043.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7075.13,100,MS-DRG,5660.104,other,100% UHC DRG rate for inpatient setting,7075.13,100,MS-DRG,5660.104,other,100% UHC DRG rate for inpatient setting,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2956.26,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10405.09,100,MS-DRG,8324.072,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2898.3,13526.62,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23207.9,130,MS-DRG,18566.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7476.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7476.37,100,,5981.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7850.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15055.54,100,MS-DRG,12044.432,other,100% UHC DRG rate for inpatient setting,15055.54,100,MS-DRG,12044.432,other,100% UHC DRG rate for inpatient setting,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7625.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17852.23,100,MS-DRG,14281.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7476.37,23207.9,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,65176.51,130,MS-DRG,52141.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2666.93,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2666.93,100,,2133.544,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2800.27,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,49650.83,100,MS-DRG,39720.664,other,100% UHC DRG rate for inpatient setting,49650.83,100,MS-DRG,39720.664,other,100% UHC DRG rate for inpatient setting,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2720.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,50135.78,100,MS-DRG,40108.624,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2666.93,65176.51,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,46078.97,130,MS-DRG,36863.176,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1403.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1403.17,100,,1122.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1473.33,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33908.47,100,MS-DRG,27126.776,other,100% UHC DRG rate for inpatient setting,33908.47,100,MS-DRG,27126.776,other,100% UHC DRG rate for inpatient setting,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1431.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35445.36,100,MS-DRG,28356.288,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1403.17,46078.97,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29764.16,130,MS-DRG,23811.328,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1058.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1058.17,100,,846.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1111.08,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20459.94,100,MS-DRG,16367.952,other,100% UHC DRG rate for inpatient setting,20459.94,100,MS-DRG,16367.952,other,100% UHC DRG rate for inpatient setting,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1079.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22895.51,100,MS-DRG,18316.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1058.17,29764.16,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,47199.28,130,MS-DRG,37759.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6534.44,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6534.44,100,,5227.552,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6861.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,34831.96,100,MS-DRG,27865.568,other,100% UHC DRG rate for inpatient setting,34831.96,100,MS-DRG,27865.568,other,100% UHC DRG rate for inpatient setting,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6665.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,36307.14,100,MS-DRG,29045.712,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6534.44,47199.28,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19900.18,130,MS-DRG,15920.144,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15979.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15979.51,100,,12783.608,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16778.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12328.92,100,MS-DRG,9863.136,other,100% UHC DRG rate for inpatient setting,12328.92,100,MS-DRG,9863.136,other,100% UHC DRG rate for inpatient setting,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16299.1,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15307.83,100,MS-DRG,12246.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12328.92,19900.18,
NORMAL NEWBORN,795,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,6968.38,130,MS-DRG,5574.704,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,815.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,815.96,100,,652.768,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,856.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,1669.07,100,MS-DRG,1335.256,other,100% UHC DRG rate for inpatient setting,1669.07,100,MS-DRG,1335.256,other,100% UHC DRG rate for inpatient setting,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,832.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,5360.29,100,MS-DRG,4288.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,815.96,6968.38,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19182.4,130,MS-DRG,15345.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3935.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3935.91,100,,3148.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4132.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11737.26,100,MS-DRG,9389.808,other,100% UHC DRG rate for inpatient setting,11737.26,100,MS-DRG,9389.808,other,100% UHC DRG rate for inpatient setting,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4014.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14755.69,100,MS-DRG,11804.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3935.91,19182.4,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14941.07,130,MS-DRG,11952.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3935.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3935.91,100,,3148.728,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4132.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8241.07,100,MS-DRG,6592.856,other,100% UHC DRG rate for inpatient setting,8241.07,100,MS-DRG,6592.856,other,100% UHC DRG rate for inpatient setting,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4014.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11493.13,100,MS-DRG,9194.504,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3935.91,14941.07,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13326.86,130,MS-DRG,10661.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6712.68,100,MS-DRG,5370.144,other,100% UHC DRG rate for inpatient setting,6712.68,100,MS-DRG,5370.144,other,100% UHC DRG rate for inpatient setting,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,10251.43,100,MS-DRG,8201.144,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6712.68,13326.86,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,54681.11,130,MS-DRG,43744.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10712.94,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10712.94,100,,8570.352,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11248.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40999.32,100,MS-DRG,32799.456,other,100% UHC DRG rate for inpatient setting,40999.32,100,MS-DRG,32799.456,other,100% UHC DRG rate for inpatient setting,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10927.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,42062.39,100,MS-DRG,33649.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10712.94,54681.11,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33229.48,130,MS-DRG,26583.584,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7992.19,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7992.19,100,,6393.752,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8391.79,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23316.47,100,MS-DRG,18653.176,other,100% UHC DRG rate for inpatient setting,23316.47,100,MS-DRG,18653.176,other,100% UHC DRG rate for inpatient setting,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8152.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25561.14,100,MS-DRG,20448.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7992.19,33229.48,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22909.77,130,MS-DRG,18327.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5252.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5252.37,100,,4201.896,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5514.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14809.77,100,MS-DRG,11847.816,other,100% UHC DRG rate for inpatient setting,14809.77,100,MS-DRG,11847.816,other,100% UHC DRG rate for inpatient setting,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5357.42,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17622.9,100,MS-DRG,14098.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5252.37,22909.77,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,39384.19,130,MS-DRG,31507.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10336.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10336.54,100,,8269.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10853.37,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28054.73,100,MS-DRG,22443.784,other,100% UHC DRG rate for inpatient setting,28054.73,100,MS-DRG,22443.784,other,100% UHC DRG rate for inpatient setting,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10543.27,102,,,other,102% GA Medicaid DRG rate for inpatient setting,30295.53,100,MS-DRG,24236.424,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10336.54,39384.19,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23597.39,130,MS-DRG,18877.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4985.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4985.49,100,,3988.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5234.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15376.61,100,MS-DRG,12301.288,other,100% UHC DRG rate for inpatient setting,15376.61,100,MS-DRG,12301.288,other,100% UHC DRG rate for inpatient setting,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5085.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18151.84,100,MS-DRG,14521.472,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4985.49,23597.39,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17094.36,130,MS-DRG,13675.488,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4102.99,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4102.99,100,,3282.392,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4308.14,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10016.06,100,MS-DRG,8012.848,other,100% UHC DRG rate for inpatient setting,10016.06,100,MS-DRG,8012.848,other,100% UHC DRG rate for inpatient setting,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4185.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13149.51,100,MS-DRG,10519.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4102.99,17094.36,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15064.54,130,MS-DRG,12051.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8342.86,100,MS-DRG,6674.288,other,100% UHC DRG rate for inpatient setting,8342.86,100,MS-DRG,6674.288,other,100% UHC DRG rate for inpatient setting,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,11588.11,100,MS-DRG,9270.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8342.86,15064.54,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12439.44,130,MS-DRG,9951.552,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6178.94,100,MS-DRG,4943.152,other,100% UHC DRG rate for inpatient setting,6178.94,100,MS-DRG,4943.152,other,100% UHC DRG rate for inpatient setting,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,9568.8,100,MS-DRG,7655.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6178.94,12439.44,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11511.88,130,MS-DRG,9209.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5414.33,100,MS-DRG,4331.464,other,100% UHC DRG rate for inpatient setting,5414.33,100,MS-DRG,4331.464,other,100% UHC DRG rate for inpatient setting,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,8855.29,100,MS-DRG,7084.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5414.33,11511.88,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26929.23,130,MS-DRG,21543.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10724.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10724.15,100,,8579.32,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11260.36,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18123.08,100,MS-DRG,14498.464,other,100% UHC DRG rate for inpatient setting,18123.08,100,MS-DRG,14498.464,other,100% UHC DRG rate for inpatient setting,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10938.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20714.79,100,MS-DRG,16571.832,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10724.15,26929.23,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17034.13,130,MS-DRG,13627.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5074.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5074.08,100,,4059.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5327.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9966.41,100,MS-DRG,7973.128,other,100% UHC DRG rate for inpatient setting,9966.41,100,MS-DRG,7973.128,other,100% UHC DRG rate for inpatient setting,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5175.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13103.18,100,MS-DRG,10482.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5074.08,17034.13,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15027.4,130,MS-DRG,12021.92,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2583.57,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2583.57,100,,2066.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2712.75,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8312.24,100,MS-DRG,6649.792,other,100% UHC DRG rate for inpatient setting,8312.24,100,MS-DRG,6649.792,other,100% UHC DRG rate for inpatient setting,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2635.25,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11559.54,100,MS-DRG,9247.632,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2583.57,15027.4,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19033.85,130,MS-DRG,15227.08,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5601.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5601.11,100,,4480.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5881.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11614.79,100,MS-DRG,9291.832,other,100% UHC DRG rate for inpatient setting,11614.79,100,MS-DRG,9291.832,other,100% UHC DRG rate for inpatient setting,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5713.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14641.42,100,MS-DRG,11713.136,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5601.11,19033.85,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13985.39,130,MS-DRG,11188.312,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3173.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3173.03,100,,2538.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3331.68,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7453.29,100,MS-DRG,5962.632,other,100% UHC DRG rate for inpatient setting,7453.29,100,MS-DRG,5962.632,other,100% UHC DRG rate for inpatient setting,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3236.49,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10757.99,100,MS-DRG,8606.392,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3173.03,13985.39,
COAGULATION DISORDERS,813,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20603.87,130,MS-DRG,16483.096,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4563.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4563.12,100,,3650.496,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4791.27,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12909,100,MS-DRG,10327.2,other,100% UHC DRG rate for inpatient setting,12909,100,MS-DRG,10327.2,other,100% UHC DRG rate for inpatient setting,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4654.38,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15849.13,100,MS-DRG,12679.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4563.12,20603.87,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26306.84,130,MS-DRG,21045.472,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4203.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4203.54,100,,3362.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4413.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17610.03,100,MS-DRG,14088.024,other,100% UHC DRG rate for inpatient setting,17610.03,100,MS-DRG,14088.024,other,100% UHC DRG rate for inpatient setting,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4287.61,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20236.03,100,MS-DRG,16188.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4203.54,26306.84,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14924,130,MS-DRG,11939.2,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3296.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3296.75,100,,2637.4,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3461.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8227.01,100,MS-DRG,6581.608,other,100% UHC DRG rate for inpatient setting,8227.01,100,MS-DRG,6581.608,other,100% UHC DRG rate for inpatient setting,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3362.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11480,100,MS-DRG,9184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3296.75,14924,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12073.02,130,MS-DRG,9658.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2167.18,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2167.18,100,,1733.744,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2275.54,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5876.91,100,MS-DRG,4701.528,other,100% UHC DRG rate for inpatient setting,5876.91,100,MS-DRG,4701.528,other,100% UHC DRG rate for inpatient setting,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2210.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9286.94,100,MS-DRG,7429.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2167.18,12073.02,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,33220.46,130,MS-DRG,26576.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18660.13,100,MS-DRG,14928.104,other,100% UHC DRG rate for inpatient setting,18660.13,100,MS-DRG,14928.104,other,100% UHC DRG rate for inpatient setting,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,25554.2,100,MS-DRG,20443.36,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18660.13,33220.46,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19309.89,130,MS-DRG,15447.912,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9707.4,100,MS-DRG,7765.92,other,100% UHC DRG rate for inpatient setting,9707.4,100,MS-DRG,7765.92,other,100% UHC DRG rate for inpatient setting,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,14853.76,100,MS-DRG,11883.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9707.4,19309.89,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14050.63,130,MS-DRG,11240.504,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7507.08,100,MS-DRG,6005.664,other,100% UHC DRG rate for inpatient setting,7507.08,100,MS-DRG,6005.664,other,100% UHC DRG rate for inpatient setting,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,10808.18,100,MS-DRG,8646.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7507.08,14050.63,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,65644.31,130,MS-DRG,52515.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17623.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,17623.03,100,,14098.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18504.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50036.44,100,MS-DRG,40029.152,other,100% UHC DRG rate for inpatient setting,50036.44,100,MS-DRG,40029.152,other,100% UHC DRG rate for inpatient setting,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17975.49,102,,,other,102% GA Medicaid DRG rate for inpatient setting,50495.62,100,MS-DRG,40396.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17623.03,65644.31,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27350.87,130,MS-DRG,21880.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7442.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7442.35,100,,5953.88,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7814.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18470.63,100,MS-DRG,14776.504,other,100% UHC DRG rate for inpatient setting,18470.63,100,MS-DRG,14776.504,other,100% UHC DRG rate for inpatient setting,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7591.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21039.13,100,MS-DRG,16831.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7442.35,27350.87,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17379.47,130,MS-DRG,13903.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4214.75,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4214.75,100,,3371.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4425.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10251.07,100,MS-DRG,8200.856,other,100% UHC DRG rate for inpatient setting,10251.07,100,MS-DRG,8200.856,other,100% UHC DRG rate for inpatient setting,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4299.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13368.82,100,MS-DRG,10695.056,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4214.75,17379.47,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,50136.61,130,MS-DRG,40109.288,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13912.13,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13912.13,100,,11129.704,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14607.74,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37253.22,100,MS-DRG,29802.576,other,100% UHC DRG rate for inpatient setting,37253.22,100,MS-DRG,29802.576,other,100% UHC DRG rate for inpatient setting,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14190.37,102,,,other,102% GA Medicaid DRG rate for inpatient setting,38566.62,100,MS-DRG,30853.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13912.13,50136.61,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27358.89,130,MS-DRG,21887.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7503.65,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7503.65,100,,6002.92,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7878.84,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18477.25,100,MS-DRG,14781.8,other,100% UHC DRG rate for inpatient setting,18477.25,100,MS-DRG,14781.8,other,100% UHC DRG rate for inpatient setting,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7653.73,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21045.3,100,MS-DRG,16836.24,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7503.65,27358.89,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17907.5,130,MS-DRG,14326,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4917.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4917.46,100,,3933.968,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5163.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10686.34,100,MS-DRG,8549.072,other,100% UHC DRG rate for inpatient setting,10686.34,100,MS-DRG,8549.072,other,100% UHC DRG rate for inpatient setting,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5015.81,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13775,100,MS-DRG,11020,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4917.46,17907.5,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,51399.47,130,MS-DRG,41119.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14734.07,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14734.07,100,,11787.256,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15470.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36317.32,100,MS-DRG,29053.856,other,100% UHC DRG rate for inpatient setting,36317.32,100,MS-DRG,29053.856,other,100% UHC DRG rate for inpatient setting,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15028.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,39538.05,100,MS-DRG,31630.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14734.07,51399.47,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,28205.15,130,MS-DRG,22564.12,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6559.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6559.86,100,,5247.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6887.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19174.83,100,MS-DRG,15339.864,other,100% UHC DRG rate for inpatient setting,19174.83,100,MS-DRG,15339.864,other,100% UHC DRG rate for inpatient setting,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6691.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21696.27,100,MS-DRG,17357.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6559.86,28205.15,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21410.97,130,MS-DRG,17128.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4727.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4727.58,100,,3782.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4963.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,835775,100,MS-DRG,668620,other,100% UHC DRG rate for inpatient setting,835775,100,MS-DRG,668620,other,100% UHC DRG rate for inpatient setting,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4822.13,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16469.98,100,MS-DRG,13175.984,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4727.58,835775,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,36603.48,130,MS-DRG,29282.784,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8612.66,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8612.66,100,,6890.128,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9043.29,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26097.7,100,MS-DRG,20878.16,other,100% UHC DRG rate for inpatient setting,26097.7,100,MS-DRG,20878.16,other,100% UHC DRG rate for inpatient setting,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8784.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28156.52,100,MS-DRG,22525.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8612.66,36603.48,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20816.69,130,MS-DRG,16653.352,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3571.48,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3571.48,100,,2857.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3750.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13084.43,100,MS-DRG,10467.544,other,100% UHC DRG rate for inpatient setting,13084.43,100,MS-DRG,10467.544,other,100% UHC DRG rate for inpatient setting,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3642.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16012.84,100,MS-DRG,12810.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3571.48,20816.69,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15738.14,130,MS-DRG,12590.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8356.1,100,MS-DRG,6684.88,other,100% UHC DRG rate for inpatient setting,8356.1,100,MS-DRG,6684.88,other,100% UHC DRG rate for inpatient setting,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,12106.26,100,MS-DRG,9685.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8356.1,15738.14,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12349.09,130,MS-DRG,9879.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6104.47,100,MS-DRG,4883.576,other,100% UHC DRG rate for inpatient setting,6104.47,100,MS-DRG,4883.576,other,100% UHC DRG rate for inpatient setting,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,9499.3,100,MS-DRG,7599.44,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6104.47,12349.09,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10081.36,130,MS-DRG,8065.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4235.15,100,MS-DRG,3388.12,other,100% UHC DRG rate for inpatient setting,4235.15,100,MS-DRG,3388.12,other,100% UHC DRG rate for inpatient setting,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,7754.89,100,MS-DRG,6203.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4235.15,10081.36,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,834,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,61150.01,130,MS-DRG,48920.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30811.14,100,,,other,100% GA Medicaid DRG rate for inpatient setting,30811.14,100,,24648.912,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32351.7,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,46331.73,100,MS-DRG,37065.384,other,100% UHC DRG rate for inpatient setting,46331.73,100,MS-DRG,37065.384,other,100% UHC DRG rate for inpatient setting,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31427.36,102,,,other,102% GA Medicaid DRG rate for inpatient setting,47038.47,100,MS-DRG,37630.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,30811.14,61150.01,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,835,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,27384.98,130,MS-DRG,21907.984,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8842.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8842.91,100,,7074.328,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9285.06,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18498.76,100,MS-DRG,14799.008,other,100% UHC DRG rate for inpatient setting,18498.76,100,MS-DRG,14799.008,other,100% UHC DRG rate for inpatient setting,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9019.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,21065.37,100,MS-DRG,16852.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8842.91,27384.98,
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,836,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19117.15,130,MS-DRG,15293.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3580.07,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3580.07,100,,2864.056,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3759.08,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9907.66,100,MS-DRG,7926.128,other,100% UHC DRG rate for inpatient setting,9907.66,100,MS-DRG,7926.128,other,100% UHC DRG rate for inpatient setting,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3651.68,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14705.5,100,MS-DRG,11764.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3580.07,19117.15,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,53570.82,130,MS-DRG,42856.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17482.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,17482.86,100,,13986.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18357,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39360.87,100,MS-DRG,31488.696,other,100% UHC DRG rate for inpatient setting,39360.87,100,MS-DRG,31488.696,other,100% UHC DRG rate for inpatient setting,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17832.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,41208.32,100,MS-DRG,32966.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17482.86,53570.82,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25037.95,130,MS-DRG,20030.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5523.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5523.74,100,,4418.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5799.92,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16156.11,100,MS-DRG,12924.888,other,100% UHC DRG rate for inpatient setting,16156.11,100,MS-DRG,12924.888,other,100% UHC DRG rate for inpatient setting,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5634.21,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19259.96,100,MS-DRG,15407.968,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5523.74,25037.95,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18024.96,130,MS-DRG,14419.968,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3754.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3754.26,100,,3003.408,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3941.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10783.15,100,MS-DRG,8626.52,other,100% UHC DRG rate for inpatient setting,10783.15,100,MS-DRG,8626.52,other,100% UHC DRG rate for inpatient setting,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3829.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13865.35,100,MS-DRG,11092.28,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3754.26,18024.96,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,36316.38,130,MS-DRG,29053.104,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15550.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,15550.04,100,,12440.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16327.54,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25861.03,100,MS-DRG,20688.824,other,100% UHC DRG rate for inpatient setting,25861.03,100,MS-DRG,20688.824,other,100% UHC DRG rate for inpatient setting,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15861.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27935.68,100,MS-DRG,22348.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15550.04,36316.38,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20739.39,130,MS-DRG,16591.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5312.55,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5312.55,100,,4250.04,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5578.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13020.71,100,MS-DRG,10416.568,other,100% UHC DRG rate for inpatient setting,13020.71,100,MS-DRG,10416.568,other,100% UHC DRG rate for inpatient setting,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5418.8,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15953.38,100,MS-DRG,12762.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5312.55,20739.39,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15648.8,130,MS-DRG,12519.04,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4252.88,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4252.88,100,,3402.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4465.52,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8824.46,100,MS-DRG,7059.568,other,100% UHC DRG rate for inpatient setting,8824.46,100,MS-DRG,7059.568,other,100% UHC DRG rate for inpatient setting,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4337.94,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12037.54,100,MS-DRG,9630.032,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4252.88,15648.8,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23621.49,130,MS-DRG,18897.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4739.92,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4739.92,100,,3791.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4976.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15396.47,100,MS-DRG,12317.176,other,100% UHC DRG rate for inpatient setting,15396.47,100,MS-DRG,12317.176,other,100% UHC DRG rate for inpatient setting,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4834.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18170.38,100,MS-DRG,14536.304,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4739.92,23621.49,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,16560.31,130,MS-DRG,13248.248,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3204.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3204.8,100,,2563.84,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3365.04,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9575.83,100,MS-DRG,7660.664,other,100% UHC DRG rate for inpatient setting,9575.83,100,MS-DRG,7660.664,other,100% UHC DRG rate for inpatient setting,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3268.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12738.7,100,MS-DRG,10190.96,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3204.8,16560.31,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13626,130,MS-DRG,10900.8,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2698.7,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2698.7,100,,2158.96,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2833.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7157.05,100,MS-DRG,5725.64,other,100% UHC DRG rate for inpatient setting,7157.05,100,MS-DRG,5725.64,other,100% UHC DRG rate for inpatient setting,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2752.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10481.54,100,MS-DRG,8385.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2698.7,13626,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29478.05,130,MS-DRG,23582.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8201.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8201.5,100,,6561.2,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8611.58,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20224.1,100,MS-DRG,16179.28,other,100% UHC DRG rate for inpatient setting,20224.1,100,MS-DRG,16179.28,other,100% UHC DRG rate for inpatient setting,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8365.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22675.42,100,MS-DRG,18140.336,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8201.5,29478.05,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17116.45,130,MS-DRG,13693.16,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4607.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4607.6,100,,3686.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4837.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10034.27,100,MS-DRG,8027.416,other,100% UHC DRG rate for inpatient setting,10034.27,100,MS-DRG,8027.416,other,100% UHC DRG rate for inpatient setting,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4699.75,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13166.5,100,MS-DRG,10533.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4607.6,17116.45,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13337.9,130,MS-DRG,10670.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2303.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2303.24,100,,1842.592,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2418.4,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6284.86,100,MS-DRG,5027.888,other,100% UHC DRG rate for inpatient setting,6284.86,100,MS-DRG,5027.888,other,100% UHC DRG rate for inpatient setting,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2349.3,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10259.92,100,MS-DRG,8207.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2303.24,13337.9,
RADIOTHERAPY,849,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,31961.62,130,MS-DRG,25569.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3230.22,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3230.22,100,,2584.176,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3391.73,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22271.34,100,MS-DRG,17817.072,other,100% UHC DRG rate for inpatient setting,22271.34,100,MS-DRG,17817.072,other,100% UHC DRG rate for inpatient setting,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3294.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24585.86,100,MS-DRG,19668.688,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3230.22,31961.62,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,55129.83,130,MS-DRG,44103.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20934.35,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20934.35,100,,16747.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21981.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,41369.21,100,MS-DRG,33095.368,other,100% UHC DRG rate for inpatient setting,41369.21,100,MS-DRG,33095.368,other,100% UHC DRG rate for inpatient setting,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21353.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,42407.56,100,MS-DRG,33926.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20934.35,55129.83,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25404.37,130,MS-DRG,20323.496,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8657.89,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8657.89,100,,6926.312,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9090.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16866.11,100,MS-DRG,13492.888,other,100% UHC DRG rate for inpatient setting,16866.11,100,MS-DRG,13492.888,other,100% UHC DRG rate for inpatient setting,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8831.05,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19541.82,100,MS-DRG,15633.456,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8657.89,25404.37,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22027.36,130,MS-DRG,17621.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5462.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5462.06,100,,4369.648,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5735.16,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14082.4,100,MS-DRG,11265.92,other,100% UHC DRG rate for inpatient setting,14082.4,100,MS-DRG,11265.92,other,100% UHC DRG rate for inpatient setting,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5571.3,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16944.12,100,MS-DRG,13555.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5462.06,22027.36,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,49398.75,130,MS-DRG,39519,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14995.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14995.72,100,,11996.576,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15745.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,36645.01,100,MS-DRG,29316.008,other,100% UHC DRG rate for inpatient setting,36645.01,100,MS-DRG,29316.008,other,100% UHC DRG rate for inpatient setting,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15295.63,102,,,other,102% GA Medicaid DRG rate for inpatient setting,37999.04,100,MS-DRG,30399.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14995.72,49398.75,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26383.14,130,MS-DRG,21106.512,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6672.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6672.74,100,,5338.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7006.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17672.92,100,MS-DRG,14138.336,other,100% UHC DRG rate for inpatient setting,17672.92,100,MS-DRG,14138.336,other,100% UHC DRG rate for inpatient setting,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6806.19,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20294.72,100,MS-DRG,16235.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6672.74,26383.14,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17827.19,130,MS-DRG,14261.752,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5846.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5846.31,100,,4677.048,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6138.62,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10620.14,100,MS-DRG,8496.112,other,100% UHC DRG rate for inpatient setting,10620.14,100,MS-DRG,8496.112,other,100% UHC DRG rate for inpatient setting,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5963.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13713.22,100,MS-DRG,10970.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5846.31,17827.19,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23434.78,130,MS-DRG,18747.824,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5870.6,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5870.6,100,,4696.48,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6164.13,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15242.55,100,MS-DRG,12194.04,other,100% UHC DRG rate for inpatient setting,15242.55,100,MS-DRG,12194.04,other,100% UHC DRG rate for inpatient setting,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5988.02,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18026.75,100,MS-DRG,14421.4,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5870.6,23434.78,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15037.44,130,MS-DRG,12029.952,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3220.87,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3220.87,100,,2576.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3381.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8320.51,100,MS-DRG,6656.408,other,100% UHC DRG rate for inpatient setting,8320.51,100,MS-DRG,6656.408,other,100% UHC DRG rate for inpatient setting,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3285.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11567.26,100,MS-DRG,9253.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3220.87,15037.44,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13805.7,130,MS-DRG,11044.56,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3019.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3019.03,100,,2415.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3169.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7305.17,100,MS-DRG,5844.136,other,100% UHC DRG rate for inpatient setting,7305.17,100,MS-DRG,5844.136,other,100% UHC DRG rate for inpatient setting,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3079.41,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10619.77,100,MS-DRG,8495.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3019.03,13805.7,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21405.96,130,MS-DRG,17124.768,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2932.69,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2932.69,100,,2346.152,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3079.32,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13570.17,100,MS-DRG,10856.136,other,100% UHC DRG rate for inpatient setting,13570.17,100,MS-DRG,10856.136,other,100% UHC DRG rate for inpatient setting,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2991.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16466.12,100,MS-DRG,13172.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2932.69,21405.96,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14156.04,130,MS-DRG,11324.832,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2687.49,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2687.49,100,,2149.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2821.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7593.97,100,MS-DRG,6075.176,other,100% UHC DRG rate for inpatient setting,7593.97,100,MS-DRG,6075.176,other,100% UHC DRG rate for inpatient setting,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2741.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10889.26,100,MS-DRG,8711.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2687.49,14156.04,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25947.45,130,MS-DRG,20757.96,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6618.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6618.17,100,,5294.536,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6949.07,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17313.78,100,MS-DRG,13851.024,other,100% UHC DRG rate for inpatient setting,17313.78,100,MS-DRG,13851.024,other,100% UHC DRG rate for inpatient setting,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6750.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19959.58,100,MS-DRG,15967.664,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6618.17,25947.45,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15840.53,130,MS-DRG,12672.424,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2899.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2899.79,100,,2319.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3044.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8982.51,100,MS-DRG,7186.008,other,100% UHC DRG rate for inpatient setting,8982.51,100,MS-DRG,7186.008,other,100% UHC DRG rate for inpatient setting,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2957.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12185.02,100,MS-DRG,9748.016,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2899.79,15840.53,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11877.27,130,MS-DRG,9501.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2899.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2899.79,100,,2319.832,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3044.78,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5715.54,100,MS-DRG,4572.432,other,100% UHC DRG rate for inpatient setting,5715.54,100,MS-DRG,4572.432,other,100% UHC DRG rate for inpatient setting,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2957.79,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9136.36,100,MS-DRG,7309.088,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2899.79,11877.27,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,74861.81,130,MS-DRG,59889.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22345.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,22345.38,100,,17876.304,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23462.64,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57634.55,100,MS-DRG,46107.64,other,100% UHC DRG rate for inpatient setting,57634.55,100,MS-DRG,46107.64,other,100% UHC DRG rate for inpatient setting,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22792.28,102,,,other,102% GA Medicaid DRG rate for inpatient setting,57586.01,100,MS-DRG,46068.808,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22345.38,74861.81,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,7,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,128081.73,130,MS-DRG,102465.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37328.39,100,,,other,100% GA Medicaid DRG rate for inpatient setting,37328.39,100,,29862.712,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,39194.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16406.02,100,MS-DRG,13124.816,other,100% UHC DRG rate for inpatient setting,16406.02,100,MS-DRG,13124.816,other,100% UHC DRG rate for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,38074.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,98524.41,100,MS-DRG,78819.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16406.02,128081.73,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15282.38,130,MS-DRG,12225.904,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3720.62,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3720.62,100,,2976.496,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3906.65,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8522.42,100,MS-DRG,6817.936,other,100% UHC DRG rate for inpatient setting,8522.42,100,MS-DRG,6817.936,other,100% UHC DRG rate for inpatient setting,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3795.03,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11755.68,100,MS-DRG,9404.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3720.62,15282.38,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42402.83,130,MS-DRG,33922.264,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7322,100,,,other,100% GA Medicaid DRG rate for inpatient setting,7322,100,,5857.6,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7688.1,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30878.16,100,MS-DRG,24702.528,other,100% UHC DRG rate for inpatient setting,30878.16,100,MS-DRG,24702.528,other,100% UHC DRG rate for inpatient setting,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7468.44,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32617.56,100,MS-DRG,26094.048,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7322,42402.83,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14526.49,130,MS-DRG,11621.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2312.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2312.96,100,,1850.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2428.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7899.32,100,MS-DRG,6319.456,other,100% UHC DRG rate for inpatient setting,7899.32,100,MS-DRG,6319.456,other,100% UHC DRG rate for inpatient setting,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2359.22,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11174.22,100,MS-DRG,8939.376,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2312.96,14526.49,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14043.61,130,MS-DRG,11234.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1995.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1995.24,100,,1596.192,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2095.01,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7501.29,100,MS-DRG,6001.032,other,100% UHC DRG rate for inpatient setting,7501.29,100,MS-DRG,6001.032,other,100% UHC DRG rate for inpatient setting,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2035.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10802.78,100,MS-DRG,8642.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1995.24,14043.61,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14372.88,130,MS-DRG,11498.304,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2055.42,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2055.42,100,,1644.336,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2158.19,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7772.71,100,MS-DRG,6218.168,other,100% UHC DRG rate for inpatient setting,7772.71,100,MS-DRG,6218.168,other,100% UHC DRG rate for inpatient setting,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2096.53,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11056.06,100,MS-DRG,8844.848,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2055.42,14372.88,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23770.07,130,MS-DRG,19016.056,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2947.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2947.26,100,,2357.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3094.63,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15518.94,100,MS-DRG,12415.152,other,100% UHC DRG rate for inpatient setting,15518.94,100,MS-DRG,12415.152,other,100% UHC DRG rate for inpatient setting,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3006.21,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18284.67,100,MS-DRG,14627.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2947.26,23770.07,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22580.48,130,MS-DRG,18064.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4189.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4189.34,100,,3351.472,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4398.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14538.35,100,MS-DRG,11630.68,other,100% UHC DRG rate for inpatient setting,14538.35,100,MS-DRG,11630.68,other,100% UHC DRG rate for inpatient setting,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4273.12,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17369.6,100,MS-DRG,13895.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4189.34,22580.48,
PSYCHOSES,885,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18660.4,130,MS-DRG,14928.32,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2699.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2699.82,100,,2159.856,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2834.81,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11306.96,100,MS-DRG,9045.568,other,100% UHC DRG rate for inpatient setting,11306.96,100,MS-DRG,9045.568,other,100% UHC DRG rate for inpatient setting,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2753.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14354.15,100,MS-DRG,11483.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2699.82,18660.4,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21825.58,130,MS-DRG,17460.464,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2136.91,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2136.91,100,,1709.528,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2243.75,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13916.07,100,MS-DRG,11132.856,other,100% UHC DRG rate for inpatient setting,13916.07,100,MS-DRG,11132.856,other,100% UHC DRG rate for inpatient setting,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2179.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16788.91,100,MS-DRG,13431.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2136.91,21825.58,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17949.66,130,MS-DRG,14359.728,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2224.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2224.37,100,,1779.496,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2335.59,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10721.09,100,MS-DRG,8576.872,other,100% UHC DRG rate for inpatient setting,10721.09,100,MS-DRG,8576.872,other,100% UHC DRG rate for inpatient setting,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2268.86,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13807.43,100,MS-DRG,11045.944,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2224.37,17949.66,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10710.78,130,MS-DRG,8568.624,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2158.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2158.96,100,,1727.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2266.91,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4753.99,100,MS-DRG,3803.192,other,100% UHC DRG rate for inpatient setting,4753.99,100,MS-DRG,3803.192,other,100% UHC DRG rate for inpatient setting,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2202.14,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8239.06,100,MS-DRG,6591.248,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2158.96,10710.78,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21093.76,130,MS-DRG,16875.008,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1652.11,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1652.11,100,,1321.688,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1734.72,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13312.82,100,MS-DRG,10650.256,other,100% UHC DRG rate for inpatient setting,13312.82,100,MS-DRG,10650.256,other,100% UHC DRG rate for inpatient setting,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1685.15,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16225.97,100,MS-DRG,12980.776,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1652.11,21093.76,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22793.32,130,MS-DRG,18234.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5225.08,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5225.08,100,,4180.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5486.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14713.78,100,MS-DRG,11771.024,other,100% UHC DRG rate for inpatient setting,14713.78,100,MS-DRG,11771.024,other,100% UHC DRG rate for inpatient setting,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5329.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17533.32,100,MS-DRG,14026.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5225.08,22793.32,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13532.66,130,MS-DRG,10826.128,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7080.09,100,MS-DRG,5664.072,other,100% UHC DRG rate for inpatient setting,7080.09,100,MS-DRG,5664.072,other,100% UHC DRG rate for inpatient setting,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,10409.74,100,MS-DRG,8327.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7080.09,13532.66,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,48388.87,130,MS-DRG,38711.096,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11483.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,11483.3,100,,9186.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12057.46,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35812.55,100,MS-DRG,28650.04,other,100% UHC DRG rate for inpatient setting,35812.55,100,MS-DRG,28650.04,other,100% UHC DRG rate for inpatient setting,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11712.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,37222.21,100,MS-DRG,29777.768,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11483.3,48388.87,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23863.42,130,MS-DRG,19090.736,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5155.56,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5155.56,100,,4124.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5413.34,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15595.89,100,MS-DRG,12476.712,other,100% UHC DRG rate for inpatient setting,15595.89,100,MS-DRG,12476.712,other,100% UHC DRG rate for inpatient setting,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5258.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18356.48,100,MS-DRG,14685.184,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5155.56,23863.42,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17406.57,130,MS-DRG,13925.256,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3741.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3741.17,100,,2992.936,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3928.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10273.41,100,MS-DRG,8218.728,other,100% UHC DRG rate for inpatient setting,10273.41,100,MS-DRG,8218.728,other,100% UHC DRG rate for inpatient setting,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3816,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13389.67,100,MS-DRG,10711.736,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3741.17,17406.57,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37631.45,130,MS-DRG,30105.16,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9843.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9843.9,100,,7875.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10336.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26945.06,100,MS-DRG,21556.048,other,100% UHC DRG rate for inpatient setting,26945.06,100,MS-DRG,21556.048,other,100% UHC DRG rate for inpatient setting,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10040.77,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28947.27,100,MS-DRG,23157.816,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9843.9,37631.45,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20841.8,130,MS-DRG,16673.44,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5171.26,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5171.26,100,,4137.008,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5429.82,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13105.12,100,MS-DRG,10484.096,other,100% UHC DRG rate for inpatient setting,13105.12,100,MS-DRG,10484.096,other,100% UHC DRG rate for inpatient setting,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5274.69,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16032.15,100,MS-DRG,12825.72,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5171.26,20841.8,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23832.32,130,MS-DRG,19065.856,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3933.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3933.3,100,,3146.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4129.96,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15570.24,100,MS-DRG,12456.192,other,100% UHC DRG rate for inpatient setting,15570.24,100,MS-DRG,12456.192,other,100% UHC DRG rate for inpatient setting,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4011.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18332.55,100,MS-DRG,14666.04,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3933.3,23832.32,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,42282.36,130,MS-DRG,33825.888,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16261.72,100,,,other,100% GA Medicaid DRG rate for inpatient setting,16261.72,100,,13009.376,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17074.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,30778.86,100,MS-DRG,24623.088,other,100% UHC DRG rate for inpatient setting,30778.86,100,MS-DRG,24623.088,other,100% UHC DRG rate for inpatient setting,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16586.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,32524.89,100,MS-DRG,26019.912,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16261.72,42282.36,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25062.04,130,MS-DRG,20049.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6547.15,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6547.15,100,,5237.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6874.51,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16583.93,100,MS-DRG,13267.144,other,100% UHC DRG rate for inpatient setting,16583.93,100,MS-DRG,13267.144,other,100% UHC DRG rate for inpatient setting,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6678.09,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19278.49,100,MS-DRG,15422.792,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6547.15,25062.04,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18559.01,130,MS-DRG,14847.208,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4583.3,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4583.3,100,,3666.64,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4812.47,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11223.38,100,MS-DRG,8978.704,other,100% UHC DRG rate for inpatient setting,11223.38,100,MS-DRG,8978.704,other,100% UHC DRG rate for inpatient setting,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4674.97,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14276.16,100,MS-DRG,11420.928,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4583.3,18559.01,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19946.36,130,MS-DRG,15957.088,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.8,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4239.8,100,,3391.84,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4451.79,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12366.99,100,MS-DRG,9893.592,other,100% UHC DRG rate for inpatient setting,12366.99,100,MS-DRG,9893.592,other,100% UHC DRG rate for inpatient setting,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4324.59,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15343.35,100,MS-DRG,12274.68,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4239.8,19946.36,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14055.67,130,MS-DRG,11244.536,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2581.33,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2581.33,100,,2065.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2710.4,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7511.22,100,MS-DRG,6008.976,other,100% UHC DRG rate for inpatient setting,7511.22,100,MS-DRG,6008.976,other,100% UHC DRG rate for inpatient setting,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2632.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10812.05,100,MS-DRG,8649.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2581.33,14055.67,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22752.15,130,MS-DRG,18201.72,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5980.5,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5980.5,100,,4784.4,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6279.52,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14679.85,100,MS-DRG,11743.88,other,100% UHC DRG rate for inpatient setting,14679.85,100,MS-DRG,11743.88,other,100% UHC DRG rate for inpatient setting,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6100.11,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17501.65,100,MS-DRG,14001.32,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5980.5,22752.15,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11557.04,130,MS-DRG,9245.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2312.58,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2312.58,100,,1850.064,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2428.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5451.57,100,MS-DRG,4361.256,other,100% UHC DRG rate for inpatient setting,5451.57,100,MS-DRG,4361.256,other,100% UHC DRG rate for inpatient setting,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2358.83,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8890.03,100,MS-DRG,7112.024,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2312.58,11557.04,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20964.26,130,MS-DRG,16771.408,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4717.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4717.12,100,,3773.696,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4952.97,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13206.07,100,MS-DRG,10564.856,other,100% UHC DRG rate for inpatient setting,13206.07,100,MS-DRG,10564.856,other,100% UHC DRG rate for inpatient setting,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4811.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16126.35,100,MS-DRG,12901.08,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4717.12,20964.26,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13585.86,130,MS-DRG,10868.688,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2459.48,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2459.48,100,,1967.584,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2582.45,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7123.95,100,MS-DRG,5699.16,other,100% UHC DRG rate for inpatient setting,7123.95,100,MS-DRG,5699.16,other,100% UHC DRG rate for inpatient setting,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2508.67,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10450.66,100,MS-DRG,8360.528,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2459.48,13585.86,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23261.1,130,MS-DRG,18608.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4447.62,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4447.62,100,,3558.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4670,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15099.39,100,MS-DRG,12079.512,other,100% UHC DRG rate for inpatient setting,15099.39,100,MS-DRG,12079.512,other,100% UHC DRG rate for inpatient setting,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4536.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17893.15,100,MS-DRG,14314.52,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4447.62,23261.1,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15321.54,130,MS-DRG,12257.232,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4104.86,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4104.86,100,,3283.888,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4310.11,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8554.7,100,MS-DRG,6843.76,other,100% UHC DRG rate for inpatient setting,8554.7,100,MS-DRG,6843.76,other,100% UHC DRG rate for inpatient setting,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4186.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11785.8,100,MS-DRG,9428.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4104.86,15321.54,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11948.55,130,MS-DRG,9558.84,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2831.02,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2831.02,100,,2264.816,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2972.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5774.3,100,MS-DRG,4619.44,other,100% UHC DRG rate for inpatient setting,5774.3,100,MS-DRG,4619.44,other,100% UHC DRG rate for inpatient setting,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2887.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9191.19,100,MS-DRG,7352.952,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2831.02,11948.55,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,22460.02,130,MS-DRG,17968.016,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5009.04,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5009.04,100,,4007.232,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5259.49,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14439.05,100,MS-DRG,11551.24,other,100% UHC DRG rate for inpatient setting,14439.05,100,MS-DRG,11551.24,other,100% UHC DRG rate for inpatient setting,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5109.22,102,,,other,102% GA Medicaid DRG rate for inpatient setting,17276.94,100,MS-DRG,13821.552,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5009.04,22460.02,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15096.68,130,MS-DRG,12077.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2940.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2940.54,100,,2352.432,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3087.56,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8369.34,100,MS-DRG,6695.472,other,100% UHC DRG rate for inpatient setting,8369.34,100,MS-DRG,6695.472,other,100% UHC DRG rate for inpatient setting,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2999.35,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11612.83,100,MS-DRG,9290.264,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2940.54,15096.68,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,269549.46,130,MS-DRG,215639.568,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50683.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,50683.96,100,,40547.168,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,53218.15,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,218118.24,100,MS-DRG,174494.592,other,100% UHC DRG rate for inpatient setting,218118.24,100,MS-DRG,174494.592,other,100% UHC DRG rate for inpatient setting,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,51697.64,102,,,other,102% GA Medicaid DRG rate for inpatient setting,207345.74,100,MS-DRG,165876.592,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50683.96,269549.46,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,74408.06,130,MS-DRG,59526.448,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8360.36,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8360.36,100,,6688.288,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8778.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,57260.52,100,MS-DRG,45808.416,other,100% UHC DRG rate for inpatient setting,57260.52,100,MS-DRG,45808.416,other,100% UHC DRG rate for inpatient setting,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8527.57,102,,,other,102% GA Medicaid DRG rate for inpatient setting,57236.97,100,MS-DRG,45789.576,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8360.36,74408.06,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37222.87,130,MS-DRG,29778.296,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3997.96,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3997.96,100,,3198.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4197.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26608.26,100,MS-DRG,21286.608,other,100% UHC DRG rate for inpatient setting,26608.26,100,MS-DRG,21286.608,other,100% UHC DRG rate for inpatient setting,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4077.92,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28632.98,100,MS-DRG,22906.384,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3997.96,37222.87,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,35380.77,130,MS-DRG,28304.616,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13698.33,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13698.33,100,,10958.664,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14383.24,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25089.8,100,MS-DRG,20071.84,other,100% UHC DRG rate for inpatient setting,25089.8,100,MS-DRG,20071.84,other,100% UHC DRG rate for inpatient setting,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13972.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,27215.98,100,MS-DRG,21772.784,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13698.33,35380.77,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25949.47,130,MS-DRG,20759.576,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3593.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3593.9,100,,2875.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3773.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17315.44,100,MS-DRG,13852.352,other,100% UHC DRG rate for inpatient setting,17315.44,100,MS-DRG,13852.352,other,100% UHC DRG rate for inpatient setting,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3665.78,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19961.13,100,MS-DRG,15968.904,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3593.9,25949.47,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,25433.47,130,MS-DRG,20346.776,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3231.34,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3231.34,100,,2585.072,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3392.9,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16890.1,100,MS-DRG,13512.08,other,100% UHC DRG rate for inpatient setting,16890.1,100,MS-DRG,13512.08,other,100% UHC DRG rate for inpatient setting,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3295.96,102,,,other,102% GA Medicaid DRG rate for inpatient setting,19564.21,100,MS-DRG,15651.368,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3231.34,25433.47,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,37220.87,130,MS-DRG,29776.696,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9929.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,9929.12,100,,7943.296,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10425.57,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26606.61,100,MS-DRG,21285.288,other,100% UHC DRG rate for inpatient setting,26606.61,100,MS-DRG,21285.288,other,100% UHC DRG rate for inpatient setting,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10127.7,102,,,other,102% GA Medicaid DRG rate for inpatient setting,28631.44,100,MS-DRG,22905.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9929.12,37220.87,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,26693.32,130,MS-DRG,21354.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6558.74,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6558.74,100,,5246.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6886.67,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,17928.62,100,MS-DRG,14342.896,other,100% UHC DRG rate for inpatient setting,17928.62,100,MS-DRG,14342.896,other,100% UHC DRG rate for inpatient setting,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6689.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,20533.32,100,MS-DRG,16426.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6558.74,26693.32,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,23575.32,130,MS-DRG,18860.256,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4960.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4960.82,100,,3968.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5208.86,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15358.4,100,MS-DRG,12286.72,other,100% UHC DRG rate for inpatient setting,15358.4,100,MS-DRG,12286.72,other,100% UHC DRG rate for inpatient setting,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5060.04,102,,,other,102% GA Medicaid DRG rate for inpatient setting,18134.86,100,MS-DRG,14507.888,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4960.82,23575.32,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20096.93,130,MS-DRG,16077.544,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13283.06,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13283.06,100,,10626.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13947.21,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12491.11,100,MS-DRG,9992.888,other,100% UHC DRG rate for inpatient setting,12491.11,100,MS-DRG,9992.888,other,100% UHC DRG rate for inpatient setting,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13548.72,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15459.18,100,MS-DRG,12367.344,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12491.11,20096.93,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15109.73,130,MS-DRG,12087.784,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3023.51,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3023.51,100,,2418.808,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3174.69,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8380.09,100,MS-DRG,6704.072,other,100% UHC DRG rate for inpatient setting,8380.09,100,MS-DRG,6704.072,other,100% UHC DRG rate for inpatient setting,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3083.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11622.87,100,MS-DRG,9298.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3023.51,15109.73,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,17507.96,130,MS-DRG,14006.368,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5710.25,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5710.25,100,,4568.2,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5995.76,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10356.99,100,MS-DRG,8285.592,other,100% UHC DRG rate for inpatient setting,10356.99,100,MS-DRG,8285.592,other,100% UHC DRG rate for inpatient setting,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5824.46,102,,,other,102% GA Medicaid DRG rate for inpatient setting,13467.66,100,MS-DRG,10774.128,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5710.25,17507.96,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,12984.54,130,MS-DRG,10387.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3075.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3075.1,100,,2460.08,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3228.85,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6628.28,100,MS-DRG,5302.624,other,100% UHC DRG rate for inpatient setting,6628.28,100,MS-DRG,5302.624,other,100% UHC DRG rate for inpatient setting,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3136.6,102,,,other,102% GA Medicaid DRG rate for inpatient setting,9988.11,100,MS-DRG,7990.488,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3075.1,12984.54,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15713.04,130,MS-DRG,12570.432,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8230.28,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8230.28,100,,6584.224,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8641.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8573.73,100,MS-DRG,6858.984,other,100% UHC DRG rate for inpatient setting,8573.73,100,MS-DRG,6858.984,other,100% UHC DRG rate for inpatient setting,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8394.89,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12086.95,100,MS-DRG,9669.56,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8230.28,15713.04,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,11354.25,130,MS-DRG,9083.4,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2874.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,2874.38,100,,2299.504,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3018.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,5198.36,100,MS-DRG,4158.688,other,100% UHC DRG rate for inpatient setting,5198.36,100,MS-DRG,4158.688,other,100% UHC DRG rate for inpatient setting,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2931.86,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8734.04,100,MS-DRG,6987.232,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2874.38,11354.25,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,10866.39,130,MS-DRG,8693.112,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1907.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,1907.03,100,,1525.624,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,2002.38,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,4882.25,100,MS-DRG,3905.8,other,100% UHC DRG rate for inpatient setting,4882.25,100,MS-DRG,3905.8,other,100% UHC DRG rate for inpatient setting,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1945.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,8358.76,100,MS-DRG,6687.008,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,1907.03,10866.39,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,66080.99,130,MS-DRG,52864.792,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22223.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,22223.9,100,,17779.12,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23335.09,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,50396.41,100,MS-DRG,40317.128,other,100% UHC DRG rate for inpatient setting,50396.41,100,MS-DRG,40317.128,other,100% UHC DRG rate for inpatient setting,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22668.37,102,,,other,102% GA Medicaid DRG rate for inpatient setting,50831.53,100,MS-DRG,40665.224,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22223.9,66080.99,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,43875.48,130,MS-DRG,35100.384,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20880.9,100,,,other,100% GA Medicaid DRG rate for inpatient setting,20880.9,100,,16704.72,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21924.95,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,32092.11,100,MS-DRG,25673.688,other,100% UHC DRG rate for inpatient setting,32092.11,100,MS-DRG,25673.688,other,100% UHC DRG rate for inpatient setting,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,21298.52,102,,,other,102% GA Medicaid DRG rate for inpatient setting,33750.37,100,MS-DRG,27000.296,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,20880.9,43875.48,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,77548.15,130,MS-DRG,62038.52,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31661.12,100,,,other,100% GA Medicaid DRG rate for inpatient setting,31661.12,100,,25328.896,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,33244.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,59848.94,100,MS-DRG,47879.152,other,100% UHC DRG rate for inpatient setting,59848.94,100,MS-DRG,47879.152,other,100% UHC DRG rate for inpatient setting,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,32294.34,102,,,other,102% GA Medicaid DRG rate for inpatient setting,59652.42,100,MS-DRG,47721.936,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,31661.12,77548.15,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,45547.93,130,MS-DRG,36438.344,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13045.33,100,,,other,100% GA Medicaid DRG rate for inpatient setting,13045.33,100,,10436.264,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13697.6,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,33470.72,100,MS-DRG,26776.576,other,100% UHC DRG rate for inpatient setting,33470.72,100,MS-DRG,26776.576,other,100% UHC DRG rate for inpatient setting,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13306.24,102,,,other,102% GA Medicaid DRG rate for inpatient setting,35036.87,100,MS-DRG,28029.496,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,13045.33,45547.93,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,30365.45,130,MS-DRG,24292.36,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8035.17,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8035.17,100,,6428.136,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8436.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20955.61,100,MS-DRG,16764.488,other,100% UHC DRG rate for inpatient setting,20955.61,100,MS-DRG,16764.488,other,100% UHC DRG rate for inpatient setting,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8195.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,23358.04,100,MS-DRG,18686.432,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8035.17,30365.45,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32392.27,130,MS-DRG,25913.816,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12149,100,,,other,100% GA Medicaid DRG rate for inpatient setting,12149,100,,9719.2,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12756.45,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22626.33,100,MS-DRG,18101.064,other,100% UHC DRG rate for inpatient setting,22626.33,100,MS-DRG,18101.064,other,100% UHC DRG rate for inpatient setting,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12391.98,102,,,other,102% GA Medicaid DRG rate for inpatient setting,24917.13,100,MS-DRG,19933.704,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12149,32392.27,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,20011.59,130,MS-DRG,16009.272,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6804.31,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6804.31,100,,5443.448,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,7144.52,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12420.78,100,MS-DRG,9936.624,other,100% UHC DRG rate for inpatient setting,12420.78,100,MS-DRG,9936.624,other,100% UHC DRG rate for inpatient setting,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6940.4,102,,,other,102% GA Medicaid DRG rate for inpatient setting,15393.53,100,MS-DRG,12314.824,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6804.31,20011.59,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,14539.54,130,MS-DRG,11631.632,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3378.98,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3378.98,100,,2703.184,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3547.93,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,7910.07,100,MS-DRG,6328.056,other,100% UHC DRG rate for inpatient setting,7910.07,100,MS-DRG,6328.056,other,100% UHC DRG rate for inpatient setting,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3446.56,102,,,other,102% GA Medicaid DRG rate for inpatient setting,11184.26,100,MS-DRG,8947.408,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3378.98,14539.54,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,73935.24,130,MS-DRG,59148.192,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16084.54,100,,,other,100% GA Medicaid DRG rate for inpatient setting,16084.54,100,,12867.632,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16888.77,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,56870.77,100,MS-DRG,45496.616,other,100% UHC DRG rate for inpatient setting,56870.77,100,MS-DRG,45496.616,other,100% UHC DRG rate for inpatient setting,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16406.23,102,,,other,102% GA Medicaid DRG rate for inpatient setting,56873.26,100,MS-DRG,45498.608,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16084.54,73935.24,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,32847.01,130,MS-DRG,26277.608,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10811.24,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10811.24,100,,8648.992,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11351.8,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,19896.41,100,MS-DRG,15917.128,other,100% UHC DRG rate for inpatient setting,19896.41,100,MS-DRG,15917.128,other,100% UHC DRG rate for inpatient setting,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11027.47,102,,,other,102% GA Medicaid DRG rate for inpatient setting,25266.93,100,MS-DRG,20213.544,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10811.24,32847.01,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,34221.32,130,MS-DRG,27377.056,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10541,100,,,other,100% GA Medicaid DRG rate for inpatient setting,10541,100,,8432.8,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,11068.05,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,24134.04,100,MS-DRG,19307.232,other,100% UHC DRG rate for inpatient setting,24134.04,100,MS-DRG,19307.232,other,100% UHC DRG rate for inpatient setting,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10751.82,102,,,other,102% GA Medicaid DRG rate for inpatient setting,26324.09,100,MS-DRG,21059.272,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10541,34221.32,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,18629.27,130,MS-DRG,14903.416,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4452.85,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4452.85,100,,3562.28,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4675.5,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11281.31,100,MS-DRG,9025.048,other,100% UHC DRG rate for inpatient setting,11281.31,100,MS-DRG,9025.048,other,100% UHC DRG rate for inpatient setting,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4541.91,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14330.21,100,MS-DRG,11464.168,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4452.85,18629.27,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,13429.25,130,MS-DRG,10743.4,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3275.82,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3275.82,100,,2620.656,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3439.61,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,6994.86,100,MS-DRG,5595.888,other,100% UHC DRG rate for inpatient setting,6994.86,100,MS-DRG,5595.888,other,100% UHC DRG rate for inpatient setting,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3341.33,102,,,other,102% GA Medicaid DRG rate for inpatient setting,10330.19,100,MS-DRG,8264.152,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3275.82,13429.25,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,19159.32,130,MS-DRG,15327.456,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4535.46,100,,,other,100% GA Medicaid DRG rate for inpatient setting,4535.46,100,,3628.368,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4762.23,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,11718.23,100,MS-DRG,9374.584,other,100% UHC DRG rate for inpatient setting,11718.23,100,MS-DRG,9374.584,other,100% UHC DRG rate for inpatient setting,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4626.17,102,,,other,102% GA Medicaid DRG rate for inpatient setting,14737.94,100,MS-DRG,11790.352,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,4535.46,19159.32,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,52530.82,130,MS-DRG,42024.656,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18963.03,100,,,other,100% GA Medicaid DRG rate for inpatient setting,18963.03,100,,15170.424,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19911.18,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,39226.81,100,MS-DRG,31381.448,other,100% UHC DRG rate for inpatient setting,39226.81,100,MS-DRG,31381.448,other,100% UHC DRG rate for inpatient setting,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,19342.29,102,,,other,102% GA Medicaid DRG rate for inpatient setting,40408.32,100,MS-DRG,32326.656,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,18963.03,52530.82,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,29899.68,130,MS-DRG,23919.744,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8592.1,100,,,other,100% GA Medicaid DRG rate for inpatient setting,8592.1,100,,6873.68,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,9021.71,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,20571.65,100,MS-DRG,16457.32,other,100% UHC DRG rate for inpatient setting,20571.65,100,MS-DRG,16457.32,other,100% UHC DRG rate for inpatient setting,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8763.95,102,,,other,102% GA Medicaid DRG rate for inpatient setting,22999.75,100,MS-DRG,18399.8,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,8592.1,29899.68,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21358.79,130,MS-DRG,17087.032,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5212.38,100,,,other,100% GA Medicaid DRG rate for inpatient setting,5212.38,100,,4169.904,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5472.99,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,13531.28,100,MS-DRG,10825.024,other,100% UHC DRG rate for inpatient setting,13531.28,100,MS-DRG,10825.024,other,100% UHC DRG rate for inpatient setting,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5316.62,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16429.84,100,MS-DRG,13143.872,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,5212.38,21358.79,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,38841.1,130,MS-DRG,31072.88,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14885.83,100,,,other,100% GA Medicaid DRG rate for inpatient setting,14885.83,100,,11908.664,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15630.12,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,27942.19,100,MS-DRG,22353.752,other,100% UHC DRG rate for inpatient setting,27942.19,100,MS-DRG,22353.752,other,100% UHC DRG rate for inpatient setting,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,15183.54,102,,,other,102% GA Medicaid DRG rate for inpatient setting,29877.77,100,MS-DRG,23902.216,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,14885.83,38841.1,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,21979.17,130,MS-DRG,17583.336,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6503.79,100,,,other,100% GA Medicaid DRG rate for inpatient setting,6503.79,100,,5203.032,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6828.98,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,14042.68,100,MS-DRG,11234.144,other,100% UHC DRG rate for inpatient setting,14042.68,100,MS-DRG,11234.144,other,100% UHC DRG rate for inpatient setting,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6633.87,102,,,other,102% GA Medicaid DRG rate for inpatient setting,16907.05,100,MS-DRG,13525.64,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,6503.79,21979.17,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,15788.33,130,MS-DRG,12630.664,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3641.37,100,,,other,100% GA Medicaid DRG rate for inpatient setting,3641.37,100,,2913.096,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3823.44,105,,,other,105% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,8939.48,100,MS-DRG,7151.584,other,100% UHC DRG rate for inpatient setting,8939.48,100,MS-DRG,7151.584,other,100% UHC DRG rate for inpatient setting,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3714.2,102,,,other,102% GA Medicaid DRG rate for inpatient setting,12144.87,100,MS-DRG,9715.896,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3641.37,15788.33,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,4943.58,130,MS-DRG,3954.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,4943.58,
UNGROUPABLE,999,MS-DRG,,,,,inpatient,,,,,,,,,,other,Not separately reimbursable for inpatient setting,4943.58,130,MS-DRG,3954.864,other,130% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,100% GA Medicaid DRG rate for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,,,,,other,Not separately reimbursable for inpatient setting,3802.75,100,MS-DRG,3042.2,other,100% CMS Medicare rates for inpatient setting. See MS-DRG rows for rates,3802.75,4943.58,